The nurse is teaching a pregnant client how to perform daily fetal movement counts.
Which instruction must be included in the teaching?

Lie on back when counting kicks.

You can begin counting fetal movements at 8 weeks gestation.

Call healthcare provider if at least 3 movements are not felt over an hour.

Count movements at the same time each day.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Lie on back when counting kicks is incorrect. It is recommended to lie on the side, preferably the left side, as lying on the back can compress major blood vessels and affect circulation to the fetus.

Choice B rationale

You can begin counting fetal movements at 8 weeks gestation is incorrect. Fetal movements are typically felt by the mother starting around 18-20 weeks of gestation, not as early as 8 weeks.

Choice C rationale

Call healthcare provider if at least 3 movements are not felt over an hour. This is an important guideline as decreased fetal movements can indicate potential issues and should be reported to the healthcare provider for further evaluation.

Choice D rationale

Count movements at the same time each day is a good practice but it is not the most critical instruction. While consistency is beneficial, the immediate action for decreased movements is more urgent.

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Correct Answer is B

Explanation

Choice A rationale

Zidovudine (ZVD) is given intravenously during labor to reduce the risk of mother-to-child transmission of HIV.

Choice B rationale

HIV-positive mothers are advised not to breastfeed as HIV can be transmitted through breast milk. This statement indicates the need for further teaching.

Choice C rationale

Administering Zidovudine (ZVD) orally to the baby immediately after birth for 6 weeks is standard practice to prevent HIV transmission.

Choice D rationale

Adherence to taking Zidovudine (ZVD) at the same time every day during pregnancy is crucial for maintaining effective drug levels and reducing the risk of mother-to-child transmission.

A. Maintain folic acid intake of 4 mcg per day. B. Increase fluids to 8-10 (8 oz) glasses per day. C. Consume the recommended daily allowance of vitamin C (85 mg). D. Increase caloric intake by 500 calories per day.

Correct Answer is B

Explanation

Choice A rationale

Maintaining a folic acid intake of 4 mcg per day is not sufficient. The recommended dose for pregnant women is 400-800 mcg to help prevent neural tube defects, but it is not specifically related to reducing the risk of preterm labor.

Choice B rationale

Increasing fluid intake to 8-10 (8 oz) glasses per day is recommended as it helps to maintain hydration, which is crucial in preventing preterm labor. Dehydration can cause uterine contractions, which can lead to preterm labor.

Choice C rationale

Consuming the recommended daily allowance of vitamin C (85 mg) is important for immune function and overall health but does not directly affect the risk of preterm labor.

Choice D rationale

Increasing caloric intake by 500 calories per day is typically recommended for breastfeeding mothers, not for preventing preterm labor during pregnancy. Proper nutrition is important, but overconsumption can lead to excessive weight gain.

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The nurse is teaching a pregnant client how to perform daily fetal movement counts.Which instruction must be included in the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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The nurse is teaching a pregnant client how to perform daily fetal movement counts.
Which instruction must be included in the teaching?