Nursing interventions and follow-up
Nursing interventions and follow-up ( 5 Questions)
A nurse is conducting a nipple-stimulated contraction stress test (CST) for a client who had a nonreactive nonstress test (NST).
Which of the following instructions should the nurse give to the client for this test?
Fasting is not required for a CST. Fasting may be necessary for other tests that involve anesthesia or sedation.
Drinking orange juice will not induce contractions. Orange juice may be given to increase fetal activity before a nonstress test (NST), which measures the FHR response to fetal movement.
The nurse should instruct the client to brush her nipple with her palm for 2 minutes.
This will stimulate the release of oxytocin and cause uterine contractions. The fetal heart rate (FHR) will be monitored for any signs of fetal distress, such as decelerations.
Lying on the back can compress the inferior vena cava and reduce blood flow to the uterus and the fetus. The client should lie on her side during the test to prevent supine hypotension syndrome.
The nurse should instruct the client to brush her nipple with her palm for 2 minutes.
This will stimulate the release of oxytocin and cause uterine contractions. The fetal heart rate (FHR) will be monitored for any signs of fetal distress, such as decelerations.
Choice A is wrong because fasting is not required for a CST. Fasting may be necessary for other tests that involve anesthesia or sedation.
Choice B is wrong because drinking orange juice will not induce contractions. Orange juice may be given to increase fetal activity before a nonstress test (NST), which measures the FHR response to fetal movement.
Choice D is wrong because lying on the back can compress the inferior vena cava and reduce blood flow to the uterus and the fetus. The client should lie on her side during the test to prevent supine hypotension syndrome.
Normal ranges for FHR are 110 to 160 beats per minute, with moderate variability and no decelerations. Normal ranges for uterine contractions are less than five in a 10-minute period, lasting less than 90 seconds each.