OB- Module 1- EAQ/Evolve Quiz

Which factors most often interfere with access to prenatal care for pregnant women, placing the mother and infant at risk? Select all that apply. A. Language differences B. Transportation barriers C. Lack of nurse practitioners D. Lack of culturally sensitive care providers E. Discrimination based on sexual orientation.

ANS: A, B, D, E

Which suggestion would the nurse make to a client with morning sickness? A. "Eat dry crackers before you get out of bed." B. "Increase your fat intake before bedtime." C. "Drink high-carbohydrate fluids with meals." D. "Eat 2 small meals a day and a snack at noon."

ANS: A "Eat dry crackers before you get out of bed." Rationale: Nausea and vomiting in the morning occur in almost 50% of all pregnancies. Eating dry crackers before getting out of bed in the morning is a simple remedy that may provide relief. B- Increasing fat intake does not relieve the nausea. C- Drinking high-carbohydrate fluids with meals is not helpful; separating gluids from solids at mealtime is more advisable. D- Eating 2 small meals a day and a snack at noon does not meet the nutritional needs of a pregnant woman, not will it relieve nausea. Some women find that eating 5 or 6 small meals daily instead of three large ones is helpful.

Which suggestion for coping with morning sickness would the nurse give to a pregnant client? A. "Eat protein before bedtime." B. "Take an antacid before breakfast." C. "Drink water until the nausea subsides." D. "Take an over-the-counter herbal remedy."

ANS: A "Eat protein before bedtime." Rationale: Nausea and vomiting in early pregnancy can be relieved with a small snack of protein before bedtime to slow digestion. B- An antacid may affect electrolyte balance, and it will not ease morning sickness. C- Drinking water until the nausea subsides is contraindicated because both fetus and mother need nourishment. D- Many medications and herbal remedies in the first trimester are contraindicated because this is the period of organogenesis, and such preparations could have teratogenic effects.

Which client statement would cause the nurse to stop the health care provider from initiating epidural anesthesia? A. "I'm not exactly sure how an epidural works." B. "I understand that the epidural might or might not take my pain away." C. "I signed the consent form for an epidural at my last clinic appointment." D. "I'm aware that the epidural could cause my contractions to slow down."

ANS: A "I'm not exactly sure how an epidural works." Rationale: A description of the various anesthetic techniques and what they entail is essential to informed consent, even if the woman received information about analgesia and anesthesia earlier in her pregnancy. Nurses play a significant role in the informed consent process by clarifying and describing procedures or by acting as the woman's advocate and asking the primary health care provider for further explanation.

A pregnant client in the third trimester tells the nurse in the prenatal clinic that she is experiencing heartburn after every meal. Which explanation would the nurse provide regarding the cause of the heartburn? A. "The esophageal sphincter relaxes and allows acid to be regurgitated." B. "In pregnancy, gastric motility increases, causing a burning sensation." C. "In pregnancy, gastric pH increases, causing acid to enter the esophagus." D. "In pregnancy, the pyloric sphincter relaxes, allowing acid to enter the intestine."

ANS: A "The esophageal sphincter relaxes and allows acid to be regurgitated." Rationale: Relaxation of the esophageal sphincter, resulting in regurgitation of acid, causes heartburn (pyrosis) during the second half of pregnancy. B- Delated emptying of stomach contents because of decreased gastric motility and displacement of the stomach because of uterine enlargement contribute to the problem. C- When gastric pH increases, gastric juices become more alkaline, leaving little or no acid to be regurgitated into the esophagus. D- Thy pyloric sphincter does not relax, and acid does not pass into the small intestine.

A nonstresss test (NST) is scheduled for a client with mild preeclampsia. During an NST, the client asks what it means when the fetal heart rate goes up every time the fetus moves. Which is an appropriate response? A. "These accelerations are a sign of fetal well-being." B. "These accelerations indicate fetal head compression." C. "Umbilical cord compression is causing these accelerations." D. "Uteroplacental insufficiency is causing these accelerations."

ANS: A "These accelerations are a sign of fetal well-being." Rationale: The NST is performed before labor begins. Accelerations with movement and a baseline variability of 5 to 15 beats/min indicate fetal well being. This reactive NST is considered positive. B- Early decelerations are associated with fetal head compression during a contraction stress test (CST) or during labor. C- Variable decelerations are associated with cord compression during a CST or during labor. D- Late decelerations during a CST or during labor are associated with uteroplacental insufficiency.

Which response would the nurse give to a client who asks how far into her pregnancy she can continue to work? A. "What activities does your job entail?" B. "How do you feel about continuing to work?" C. "Most women work throughout their pregnancies." D. "Usually women quit work at the start of their third trimester."

ANS: A "What activities does your job entail?" Rationale: More information about job activities is needed before the nurse can give a professional response. B- Although it is important to ascertain the client's feelings about continuing to work, at this time she is seeking information. C- Although it is true that most women work throughout their pregnancies, more information is needed before the nurse can respond. D- It is misinformation to state that usually women quit work at the start of the third trimester.

The nurse explains to a client that she will need additional calcium during pregnancy and that the ideal source is milk. The client states, "I never drink milk or eat milk products. They turn my stomach." Which is an appropriate reply? A. "Your practitioner can prescribe calcium supplements." B. "Just make sure that the rest of your diet is nutritionally sound." C. "Eliminating milk from your diet may cause your teeth to loosen." D. "Drinking milk is so important for your baby to develop strong bones."

ANS: A "Your practitioner can prescribe calcium supplements." Rationale: Calcium is essential to a pregnant woman's diet for the development of the fetal skeleton; it must be supplemented if the client dislikes or is allergic to milk and milk products. B- A nutritionally sound diet without dairy products does not meet the needs of the pregnant woman or her fetus. C- Dental care and oral hygiene will be more beneficial for maintaining healthy teeth than adding more calcium to the diet will. D- If milk makes the client ill, the statement "Drinking milk is so important for your baby to develop strong bones" is ineffective advice, and the dietary regimen probably will not be followed.

Which is the optimal nursing intervention to minimize perineal edema after an episiotomy? A. Applying ice packs B. Offering warm sitz baths C. Administering aspirin as needed D. Elevating the hips on a pillow

ANS: A Applying ice packs Rationale: Cold causes vasoconstriction and reduces edema by lessening the accumulation of blood and lymph at the episiotomy site; cold also deadens nerve endings and lessens the pain. B- Heat therapy alone does not resolve perineal edema. C- Aspirin is contraindicated in the early postpartum period because of the risk for hemorrhage. D- Elevating the hips provides minimal perineal relief.

A client required an extensive episiotomy because her newborn was large. Which nursing intervention will minimize edema and lessen discomfort associated with an episiotomy? A. Applying ice packs to the perineum B. Positioning the client off the incisional area C. Administering an oral analgesic to the client D. Spraying the perineum with a local anesthetic

ANS: A Applying ice packs to the perineum Rationale: Application of cold causes vasoconstriction and reduces edema by lessening the accumulation of blood and lymph at the episiotomy site. Cold also deadens nerve ending and lessens the pain. B- Positioning the client off the incisional area in a side-lying position will not lessen pain or reduce edema. C- Analgesia may diminish the pain but will not lessen the edema. D- An anesthetic spray is not recommended after an episiotomy.

Which is the initial approach the nurse would use when teaching a pregnant woman about the foods she should be eating to promote healthy growth and development of her fetus? A. Asking the client what she usually eats at each meal B. Explaining to the client why spicy foods should be avoided C. Instructing the client to add calories while continuing to eat a healthy diet D. Providing the client with a list of foods for reference when planning meals

ANS: A Asking the client what she usually eats at each meal Rationale: Successful dietary teaching should incorporate the client's food preferences and dietary patterns. B- Spicy foods are permissible if the client does not experience discomfort after eating them. C- Instructing the client to add calories while continuing to eat a healthy diet presupposes that the client has been eating a healthy diet. It does not provide for the additional protein requirements of pregnancy. D- Providing the client with a list of foods for reference when planning meals does not take into consideration the client's likes and dislikes or cultural preferences.

Which is the priority nursing action when a client at 40 weeks' gestation has an amniotomy performed to facilitate labor? A. Assessing the fetal heart rate B. Obtaining the maternal vital signs C. Documenting the time of the procedure D. Monitoring the frequency of contractions.

ANS: A Assessing the fetal heart rate Rationale: The priority nursing action is to evaluate the effect of the amniotomy on the fetus by assessing the fetal heart rate. B- Obtaining the maternal vital signs is not the priority; it can be done later. C- Although documenting the time of the amniotomy is necessary, fetal well-being is the priority concern. D- Monitoring contractions once they have started is important but does not take priority over ensuring fetal well-being.

Which instruction would the nurse give to a client in labor who begins to experience dizziness and tingling of her hands? A. Breathe into her cupped hands. B. Pant during the next 3 contractions. C. Hold her breath with the next contraction. D. Use a fast, deep, or shallow breathing pattern.

ANS: A Breathe into her cupped hands. Rationale: Dizziness and tingling of the hands are signs of respiratory alkalosis, most likely the result of hyperventilating. Breathing into cupped hands or a paper bag promotes the rebreathing of carbon dioxide. B- Panting during the next 3 contractions could cause the client to hyperventilate more. C- Holding her breath with the next contraction will not improve the client's respiratory alkalosis. D- Using a fast, deep, or shallow breathing pattern could cause the client to hyperventilate more.

At which point during a human pregnancy does the embryo become a fetus? A. During the 8th week of the pregnancy B. At the end of the 2nd week of pregnancy C. When the fertilized egg becomes implanted D. When the products of conception are seen on the ultrasound

ANS: A During the 8th week of the pregnancy Rationale: During the 8th week of pregnancy the organ systems and other structures are developed to the extent that they take the human form; at this time the embryo becomes a fetus and remains so until birth B- At the end of the 2nd week of pregnancy, the developing cells are called an embryo. C- At the time of implantation, the group of developing cells is called a blastocyst. D- The embryo can be visualized on ultrasound before it becomes a fetus.

Which instruction would the nurse include when teaching a client about a contraction stress test (CST)? A. Empty the bladder before the test. B. Eat nothing for 6 hours after the test. C. Take the prescribed alprazolam before the test. D. Be prepared to remain in the hospital for 12 hours after the test.

ANS: A Empty the bladder before the test. Rationale: The CST will take 1 to 2 hours, during which time the client is confined to bed. Movement on and off a bedpan during a CST should be avoided, so it is important to empty the bladder before the test. B- There are no food restrictions before or after this test. C- Alprazolam may interfere with results of the CST because it will sedate the fetus. If the test is explained in language that the client can comprehend, an anxiolytic should not be necessary. D- The client may go home 1 hour after the test is completed.

For which reason is an ultrasound done during the first trimester? A. Estimate fetal age B. Detect hydrocephalus C. Rule out congenital defects D. Approximate fetal linear growth

ANS: A Estimate fetal age Rationale: Measurement of the crown-rump length is useful in approximating fetal age in the first trimester. B- Hydrocephalus cannot be detected during the first trimester. C-Ultrasonography is used to detect structural defects in the second trimester. D- It is too early in this pregnancy to determine fetal linear growth.

A pregnant client's last menstrual period was on February 11. A physical assessment on July 18 would reveal the top of the fundus to be where? A. Even with the umbilicus B. Just above the symphysis pubis C. Two fingerbreadths above the umbilicus D. Halfway between the symphysis and umbilicus

ANS: A Even with the umbilicus Rationale: Around the 22nd week of gestation the top of the fundus is at the level of the umbilicus. B- Just above the symphysis pubis is too low for a pregnancy between the 5th and 6th months of gestation. C- Two fingerbreadths above the umbilicus is too high for 20 to 22 weeks' gestation. D- Halfway between the symphysis pubis and umbilicus is too low for a pregnancy between the 5th and 6th months of gestation.

While a client is being interviewed on her first prenatal visit she states that she has a 4-year-old son who was born at 41 weeks' gestation and a 3-year-old daughter who was born at 35 weeks' gestation. The client lost one pregnancy at 9 weeks and another at 18 weeks. Using the GTPAL system, how would you record this information? A. G5 T1 P1 A2 L2 B. G4 T1 P1 A2 L2 C. G4 T2 P0 A0 L2 D. G5 T2 P1 A1 L2

ANS: A G5 T1 P1 A2 L2 Rationale: The client is gravida (G) 5: the current pregnancy, the 41-week pregnancy, the 35-week pregnancy, the 9-week pregnancy, and the 18-week pregnancy. She has had 1 term (T) pregnancy (1 that lasts 40 weeks plus or minus 2 weeks): the 41-week pregnancy. The 35-week pregnancy is considered preterm (P). Pregnancies that end before 20 weeks are considered abortions, so the losses at 9 and 18 weeks would be scored as A2. The other options do not consider the present pregnancy or the correct definitions of term and preterm or do not include the abortions.

A pregnant client has two children at home, the first born at 38 weeks' gestation and the second born at 34 weeks' gestation. She has also had one miscarriage, at 18 weeks, and an elective abortion. Which is the correct summary of her obstetric history using the GTPAL system? A. G5, T1, P1, A2, L2 B. G4, T2, P2, A1, L4 C. G2, T3, P3, A2, L1 D. G3, T2, P1, A3, L3

ANS: A G5, T1, P1, A2, L2

Which statement indicates a client understands the meaning of having a reactive nonstress test? A. Normal because of increases in fetal heart rate (FHR) with fetal movement B. Abnormal because of a decrease in FHR between contractions C. Abnormal because of variability in FHR with each contraction D. Normal because the FHR remained unchanged with maternal movement

ANS: A Normal because of increases in fetal heart rate (FHR) with fetal movement Rationale: A reactive nonstress test is an expected finding because there are 2 or more increases in FHR greater than 15 beats/min associated with fetal movement; it suggests fetal well-being. There are no uterine contractions during a nonstress test. Maternal movement has no bearing on nonstress test readings; fetal movements and FHR are monitored.

Which high-risk nutritional practice must be assessed for when a pregnant client is found to be anemic? A. Pica B. Caffeine intake C. Alcohol abuse D. Artificial sweetener use

ANS: A Pica The practice of pica, especially the ingestion of heavy metals, must be considered when pregnant women are found to be anemic. Caffeine, alcohol, and artificial sweeteners are not directly linked to anemia in pregnant women.

Which recommendation would the nurse make for a pregnant patient experiencing nausea and vomiting? Select all that apply. A. Avoid an empty or excessively full stomach. B. Drink real ginger ale or tea, or use real ginger in another recipe. C. Try sucking on sour candies or smelling a citrus-scented food or product. D. Eat crackers or vanilla wafers or drink a small amount of liquid before getting out of bed. E. Eat small, carbohydrate-rich, low-fat meals throughout the day, such as toast, oatmeal, or noodle soup. F. Locate the pressure points to reduce nausea located at the middle of the wrist, and press firmly for 3 minutes.

ANS: A, B, C, D, E, F

Which are the primary goals of prenatal nursing care? Select all that apply. A. Safe birth for mother and infant B. Pregnant woman's self-management C. Promote health and well-being of mother and infant D. Satisfaction of mother and family with the birth experience E. Understand psychosocial factors that influence the woman

ANS: A, C, D Rationale: A safe birth for the mother and infant, promoting the health and well-being of mother and infant, and the satisfaction of mother and family with the birth experience are the primary goals of prenatal nursing care. B- The nursing staff is to support the pregnant woman in self-management between visits with health care professionals; it is not a primary goal of prenatal nursing care. D- Understanding psychosocial factors that influence the pregnant woman is valuable, but it is not one of the primary goals of prenatal nursing care.

Which variables are scored on a biophysical profile? Select all that apply. A. Fetal tone B. Fetal position C. Fetal movement D. Amniotic fluid index E. Fetal breathing movements F. Contraction stress test results

ANS: A, C, D, E A. Fetal tone C. Fetal movement D. Amniotic fluid index E. Fetal breathing movements Rationale: Fetal tone, fetal movement, amniotic fluid index, and fetal breathing movements are all scored on a biophysical profile. B- Fetal position is not one of the variables that are scored. F- A nonstress test, not a contraction stress test, is also part of the biophysical profile.

A client at 7 weeks' gestation tells the nurse in the prenatal clinic that she has been bothered by episodes of nausea, but no vomiting, throughout the day. What should the nurse recommend? Select all that apply. A. Focus on and repeat a rhythmic chant. B. Sit upright for 30 minutes after meals. C. Take low-sodium antacids after meals. D. Drink carbonated beverages with meals. E. Eat small, frequent meals and eat dry crackers in between.

ANS: A, E A. Focus on and repeat a rhythmic chant E. Eat small, frequent meals and eat dry crackers In between. Rationale: Focusing helps mitigate odors, tastes, and thoughts that may cause nausea. Avoiding an empty stomach decreases the occurrence of nausea associated with pregnancy. B- Sitting upright after mills will help ease heartburn but will have little effect on nausea. C- Prescribed low-sodium antacids may be taken between meals later in pregnancy to promote relief from heartburn. D- Carbonated beverages may or may not help; however, women should be advised to consume fluids between, not wth, meals.

Which statement made by a pregnant client after a prenatal class on fetal growth and development indicates the need for additional teaching? A. "The baby is smaller if the mother smokes." B. "The baby gets food from the amniotic fluid." C. "The baby's oxygen is provided by the mother." D. "The baby's umbilical cord has 2 arteries and 1 vein."

ANS: B "The baby gets food from the amniotic fluid." Rationale: The amniotic fluid serves as a protective environment; the fetus depends on the placenta, along with the umbilical blood vessels, to supply blood containing nutrients and oxygen. The rest are true statements and further teaching would not be required.

Which direction regarding sleeping position would the nurse give to a client who is 8 months' pregnant? A. "Try to sleep on your stomach." B. "Turn from side to side when in bed." C. "Elevate the head of the bed on blocks." D. "Place pillows under your knees for sleep."

ANS: B "Turn from side to side when in bed." Rationale: The side-lying position will relieve back pressure; it also promotes uterine perfusion and fetal oxygenation. A- At 32 weeks' gestation the abdomen is too distended for the pregnant woman to lie in the prone position. C- Elevating the head of the bed will not relieve back pressure; it is used to limit gastroesophageal reflux. Lying on the back is contraindicated because it puts pressure on the vena cava, resulting in hypotension and uteroplacental insufficiency. D- Pillows under the knees are contraindicated because they place pressure on the popliteal area, which compresses the venous circulation, increasing the risk of thrombophlebitis.

Which is the most appropriate response when a client asks if the nurse thinks the ordered nonstress test is necessary? A. "It's a fast, harmless procedure." B. "You seem to have doubts about this test." C. "This test is routinely done at this time in a pregnancy." D. "There may be problems, and we want to reduce the risks."

ANS: B "You seem to have doubts about this test." Rationale: Observing that the client is having doubts encourages her to discuss her fears and anxieties. Telling the client that the test is fast, harmless, or routine cuts off communication and does not allow the client to express her fears and anxiety. The mention of risk may frighten the client and does not encourage the client to discuss the situation further.

A client at 35 weeks' gestation asks the nurse why her breathing has become more difficult. How would the nurse respond? A. "Your lower rib cage is more restricted." B. "Your diaphragm has been displaced upward." C. "Your lungs have increased in size since you got pregnant." D. "The height of your rib cage has increased since you got pregnant."

ANS: B "Your diaphragm has been displaced upward." Rationale: The pressure of the enlarging fetus causes upward displacement of the diaphragm, which results in thoracic breathing; this limits the descent of the diaphragm on inspiration. A- The lower rib cage expands; it does not become restricted. C- There is no change in the size of the lungs during pregnancy. D- The thoracic cage enlarges; it does not rise.

The first day of a client's last menstrual period was July 22. What is the estimated date of birth (EDB)? A. May 7 B. April 29 C. April 22 D. March 6

ANS: B April 29

Which foods would a postpartum client complaining of leg cramps be encouraged to eat? A. Liver and raisins B. Cheese and broccoli C. Eggs and lean meats D. Whole-wheat breads and cereals

ANS: B Cheese and broccoli Rationale: The leg cramps may be related to low calcium intake; cheese and broccoli each have a high calcium content. Although liver and raisins, eggs and lean meats, and whole-wheat breads and cereals are recommended as part of a high-quality nutritional intake, they are inadequate sources of calcium.

The nurse instructs a pregnant woman in labor that she must avoid lying on her back. What is the primary reason for this instruction? A. The supine position can prolong the course of labor. B. Decreased placental perfusion is seen in the supine position. C. This position can lead to transient episodes of hypertension. D. Lying on the back interferes with free movement of the coccyx.

ANS: B Decreased placental perfusion is seen in the supine position. Rationale: In the supine position the gravid uterus impedes venous return; this causes decreased cardiac output and results in reduced placental circulation. This in turn can lead to fetal compromise. A- Although a prolonged course of labor may result if the client lies supine, this is not the most significant reason for avoiding the supine position during labor. C- The supine position may result in hypotension, not hypertension. D- Interference with free movement of the coccyx is not the most significant reason for avoiding the supine position while in labor, although it may be partially true.

Which is a consideration when planning prenatal counseling for a client who has had two uneventful pregnancies ending in term vaginal births of healthy children? A. Multiparas cope more successfully with pregnancy than do primigravidas. B. Each pregnancy is a unique experience that is stressful despite multiparity. C. This pregnancy will provoke a situational crisis because the client has two children at home. D. Support people play a lesser role because the client has had 2 prior experiences with pregnancy.

ANS: B Each pregnancy is a unique experience that is stressful despite multiparity. Rationale: Each pregnancy is unique and creates a stressful situation because it is a developmental crisis. A- It has not been determined that multiparas are more successful in coping with pregnancy than primigravidas are. This pregnancy may or may not be more stressful than the others. C- In addition, pregnancy is a developmental, not a situational, crisis. D- Support people are important during any crisis or stressful situation.

Which intervention would the nurse recommend to a client in her 37th week of gestation who calls the clinic and reports, "My ankles are so swollen"? A. Limiting fluid intake during the day B. Elevating her legs more frequently during the day C. Restricting salt intake for the remainder of her pregnancy D. Taking a mild diuretic that the health care provider will prescribe.

ANS: B Elevating her legs more frequently during the day. Rationale: Dependent edema in the ankles is a common occurrence during the latter part of pregnancy. It results from increased pressure of the uterus on the pelvic veins. Elevating the legs encourages venous return. A- Limiting fluid intake can be harmful; increased circulating blood volume during pregnancy must be maintained. C- Salt is necessary to retain fluid for the increased circulating blood volume during pregnancy. D- Diuretics are not used during pregnancy; they may decrease the circulating blood volume.

A nonstress test evaluates the condition of the fetus by comparing the fetal heart rate with which factor? A. Fetal lie B. Fetal movement C. Maternal blood pressure D. Maternal uterine contractions

ANS: B Fetal movement Rationale: In a healthy, well-oxygenated fetus the heart rate increases with fetal movement; there should be an acceleration of 15 beats with fetal movement. Fetal lie and maternal blood pressure are not a part of the evaluation of the fetus in the nonstress test. Maternal uterine contractions are used in the contraction stress test.

Which prenatal teaching is most applicable for a client who is between 13 and 24 weeks' gestation? A. Infant care, travel to the hospital, and signs of labor B. Growth of the fetus, body changes, and nutritional guidance C. Interventions for nausea and vomiting, urinary frequency, and anticipated care. D. Danger signs of preeclampsia, relaxation breathing techniques, and signs of labor

ANS: B Growth of the fetus, body changes, and nutritional guidance Rationale: Awareness of the fetus as an individual and the expected changes of pregnancy lead the client to seek information regarding fetal growth, body changes, and nutrition. A & D- Information on infant care, travel to the hospital, signs of labor, signs of preeclampsia, and relaxation breathing techniques are appropriate in the last trimester. C- Interventions for nausea and vomiting, urinary frequency, and anticipated care are appropriate for the first trimester.

During a routine prenatal visit, a client tells the nurse that she often gets muscle weakness and leg cramps. Which condition would the nurse suspect, and which suggestion is made to correct the problem? A. Hypercalcemia; avoid eating hard cheeses B. Hypocalcemia; increase her intake of milk C. Hyperkalemia; consult her health care provider D. Hypokalemia; increase intake of green leafy vegetables

ANS: B Hypocalcemia; increase her intake of milk Rationale: The most likely cause is a disturbance in the ratio of calcium to phosphorus, with the amount of serum calcium reduced and the serum phosphorous increased; milk and other dairy products are excellent sources of calcium. A- Leg cramps are related to hypocalcemia, not to hypercalcemia. C- An increased potassium level manifests as muscle weakness. D- A low potassium level should be treated with increasing bananas and oranges, not green leafy vegetables.

While conducting prenatal teaching, the nurse explains to the client there is an increase in vaginal secretions during pregnancy called leukorrhea. Which factor does the nurse identify as the cause of this increase? A. Decreased metabolic rate B. Increased production of estrogen C. Secretion from the Bartholin glands D. Supply of sodium chloride to the vaginal cells

ANS: B Increased production of estrogen Rationale: Increased estrogen production during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells. A- Increased (not decreased) metabolism leads to systemic changes but does not increase vaginal discharge. C- The amount of secretion from the Bartholin glands, which lubricates the vagina during intercourse, remains unchanged during pregnancy. D- There is no additional supply of sodium chloride to the vaginal cells during pregnancy.

According to Naegele rule, which is the expected date of delivery (EDD) of a client whose last menstrual period began on April 15? A. January 8 B. January 22 C. February 8 D. February 22

ANS: B January 22 Rationale: To determine EDD with the use of Naegele rule, subtract 3 months from the date of the last menstrual period and add 7 days; in this case the EDD is January 22. A- January 8 is 2 weeks too early according to this formula. C- February 8 is too late. D- February 22 would be 1 month past the true EDD.

How would the nurse explain physiological anemia to a pregnant client? A. Erythropoiesis decreases. B. Plasma volume increases. C. Utilization of iron decreases. D. Detoxification by the liver increases.

ANS: B Plasma volume increases. Rationale: There is a 30% to 50% increase in maternal plasma volume at the end of the first trimester, leading to hemodilution and a decrease in the concentrations of hemoglobin and erythrocytes. A- Erythropoiesis increases after the first trimester. C- Iron utilization is unrelated to the development of physiological anemia of pregnancy. D- Detoxification demands are unchanged during pregnancy.

In which position is a client placed when having a contraction stress test (CST)? A. Sims position to facilitate examination B. Semi-Fowler position to avoid hypotension C. Lithotomy position to enhance visualization D. Trendelenburg position to prevent cervical pressure

ANS: B Semi-Fowler position to avoid hypotension Rationale: The semi-Fowler position prevents supine hypotension and is recommended for both safety and comfort. A- The Sims position makes monitoring difficult. C- The lithotomy position is contraindicated for a CST because a vaginal examination is not necessary. D- The Trendelenburg position is used for shock or a prolapsed cord, not a CST.

When low back pain is a problem, which position would the nurse advise a client in labor to avoid? A. Sitting B. Supine C. Knee-chest D. Left side-lying

ANS: B Supine Rationale: Low back pain is aggravated when the client is in the supine position because of increased pressure from the fetus as the head rotates. A- A sitting position relieves back pain. C- The knee-chest position is an alternative position that a client may choose to use when laboring. D- The left side-lying position relieves back pain.

The nurse teaches a postpartum client how to care for her episiotomy to prevent infection. Which behavior indicates that the teaching has been effective? A. The perineal pad is changed twice daily. B. The client washes her hands before and after she changes a perineal pad. C. The client rinses her perineum with water after using an analgesic spray. D. The client cleanses the perineum from the anus toward the symphysis pubis.

ANS: B The client washes her hands before and after she changes a perineal pad. Rationale: Washing the hands before and after every pad change prevents the transfer of microorganisms from the hands to the genital tract or vice versa. A- Changing the perineal pad twice daily is an inadequate number of changes; soiled pads promote the growth of microorganisms because they are warm and moist and provide a medium for growth. C- Rinsing the perineum with water after using an analgesic spray interferes with the analgesic action of the spray and does not prevent infection. D- Cleansing the perineum from the anus toward the symphysis pubis promotes contamination of the vagina and urethra by organisms from the perianal area.

A pregnant client asks how smoking will affect her baby. Which information about cigarette smoking will influence the nurse's response? A. It relieves maternal tension, and the fetus responds accordingly to the reduction in stress. B. The resulting vasoconstriction affects both fetal and maternal blood vessels. C. Substances contained in smoke permeate through the placenta and compromise the fetus's well-being. D. Effects are limited because fetal circulation and maternal circulation are separated by the placental barrier.

ANS: B The resulting vasoconstriction affects both fetal and maternal blood vessels. Rationale: Cigarette smoking or continued exposure to secondary smoke causes both maternal and fetal vasoconstriction, resulting in fetal growth retardation and increased fetal and infant mortality. A- There is no clinical evidence that smoking relieves tension or that the fetus is more relaxed. C- Smoking causes vasoconstriction; permeability of the placenta to smoke is irrelevant. D- Although the fetal and maternal circulations are separate, vasoconstriction occurs in both mother and getus.

A contraction stress test (CST) performed on a client at 40 weeks' gestation is interpreted as negative. Which conclusion would the nurse draw from this interpretation? A. Testing will be repeated in 24 hours because the results indicate hyperstimulation. B. There will be weekly retesting because at this time the fetus has adequate oxygen reserves. C. Emergency birth will be considered because the fetal heart rate has early decelerations with uterine contractions. D. Induction of labor will be performed because fetal heart rate accelerations with movement are indicative of a false report.

ANS: B There will be weekly retesting because at this time the fetus has adequate oxygen reserves. Rationale: A negative test result implies that placental support is adequate. A- A negative test result does not indicate hyperstimulation. C- This is a negative test result; if there were persistent late decelerations with contractions, the test would be positive and intervention would be required. D. Fetal heart rate accelerations with movement are reassuring; an expeditious birth is not indicated.

Morning sickness generally disappears by the end of which month? A. Fifth month B. Third month C. Fourth month D. Second month

ANS: B Third month Rationale: Because of a decrease in chorionic gonadotropin, morning sickness seldom persists beyond the first trimester. Morning sickness usually ends at the end of the third month, not the second month, when the chorionic gonadotropin level falls. It is still present in the second month because of the high level of chorionic gonadotropin but has usually diminished by the fifth month.

A 42-year-old client at 39 weeks' gestation has a reactive nonstress test (NST). Which interpretation pertains to this result? A. Immediate birth is indicated B. This is the desired response at this stage of gestation. C. Further testing is unnecessary with this desired outcome. D. The result is inconclusive, indicating the need for further evaluation.

ANS: B This is the desired response at this stage of gestation. Rationale: An NST indicates that the fetus is healthy because there is an active pattern of fetal heart rate acceleration with movement. A- The result is positive and desire; immediate birth is not required. C- Further testing is needed. If the pregnancy continues, another test of fetal well-being will probably be done. D- The results were positive, not inconclusive.

Which complication is the pregnant client at risk for related to the dilation of renal pelves and ureters? A. Frequent urination B. Urinary tract infection C. Glomerular filtration rate decreases D. Increased urinary excretion of protein and albumin

ANS: B Urinary tract infection Rationale: Dilation of renal pelves and ureters during pregnancy increases the risk of urinary tract infections. A- Frequent urination is an expected occurrence during pregnancy due to increased bladder sensitivity during early pregnancy and due to bladder compression by the uterus during later pregnancy. C- By the end of the first trimester the glomerular filtration rate increases by 50% and remains elevated throughout pregnancy. D- During normal pregnancy there is an increased urinary excretion of protein and albumin, most notably after 20 weeks' gestation.

Which compensatory changes occur in the cardiovascular system during pregnancy? Select all that apply. A. Systemic vasodilation B. Increased blood volume C. Increased blood pressure D. Increased cardiac output E. Enlargement of the heart F. Decreased erythrocyte production

ANS: B, D, E Rationale: Blood volume increases to meet the metabolic demands of pregnancy. Increased cardiac output is necessary to accommodate the increased blood volume needed to meet the demands of the growing fetus. Cardiac hypertrophy is a result of the demands made by the increased blood volume and cardiac output. A- Systemic vasodilation is not expected. C- There is little variation in blood pressure- only a slight decrease during the second trimester. F- Erythrocyte production increases; because the plasma volume increases more than the red blood cell count, the hematocrit is lower.

Which findings occur with orthostatic hypotension? Select all that apply. A. Reflex tachycardia B. Feeling of faintness C. Increased cardiac output D. Increased diastolic pressure E. Decreased systolic pressure

ANS: B, E B. Feeling of faintness E. Decreased systolic pressure Rationale: Compression of the vena cava hinders venous return, which results in a decrease in the systolic pressure and decreased blood flow to the brain. This causes the client to feel faint. Blood pressure decreases when venous return is compromised. Supine hypotensive syndrome results in a reflex bradycardia where cardiac output is decreased by half.

Which general body system undergoes the most profound change during pregnancy? A. Urinary system B. Endocrine system C. Cardiovascular system D. Gastrointestinal system

ANS: C Cardiovascular system Ratonale: Total blood volume increases by 50%, making it necessary for the heart to pump harder and work more to accommodate this increase. A- Although the renal threshold is lowered in the urinary system, the major changes occur in the cardiovascular system. B- Changes in hormone levels occur in the endocrine system, but they are not as profound as changes in the cardiovascular system. D- Pressure from the growing uterus can result in digestive discomfort and altered patterns of elimination in the gastrointestinal system, but these changes are not as significant as those in the cardiovascular system.

A prenatal client's vaginal mucosa is noted to have a purplish discoloration. Which sign would be documented in the client's clinical record? A. Hegar B. Goodell C. Chadwick D. Braxton-Hicks

ANS: C Chadwick Rationale: A purplish coloration, called the Chadwick sign, results from the increased vascularity and blood vessel engorgement of the vagina. A- The Hegar sign is softening of the lower uterine segment. B- The Goodell sign is softening of the cervix. D- After the fourth month of pregnancy, irregular, painless uterine contractions, called Braxton-Hicks contractions, can be felt through the abdominal wall.

Which prenatal test provides the earliest diagnosis of fetal defects? A. Nonstress test B. Amniocentesis C. Chorionic villus sampling D. Percutaneous umbilical blood sampling

ANS: C Chorionic villus sampling Rationale: Chorionic villus sampling may be performed between 10 and 12 weeks' gestation. A- The nonstress test, which is not invasive, is a technique used for antepartum evaluation of the fetus; it does not reveal fetal defects. B- Amniocentesis may be performed after 14 weeks' gestation, when sufficient amniotic fluid is available. D- Direct access to the fetal circulation with percutaneous umbilical blood sampling may be performed during the second and third trimesters.

Which is the most highly sensitive time within the developing embryo for the risk of malformation related to environmental teratogens? A. Heart at 32 weeks' gestation B. Cleft lip at 18 weeks' gestation C. Cleft palate at 8 weeks' gestation D. Upper limbs at 24 weeks' gestation

ANS: C Cleft palate at 8 weeks' gestation Rationale: The most highly sensitive time within the developing human embryo for malformation caused by environmental teratogens is cleft palate at 8 weeks' gestation. A- The most highly sensitive time for the heart is between 6 and 9 weeks, not 32 weeks. B- The most highly sensitive period for the cleft lip is between 5 and 7 weeks, not at 18 weeks. D- The most highly sensitive time for the upper limbs is between 6 and 9 weeks, not at 24 weeks.

Which recommendation would the nurse provide the client with fluid retention during pregnancy? A. Decrease fluid intake. B. Maintain a high-sodium diet. C. Elevate the lower extremities. D. Ask the health care provider for a diuretic.

ANS: C Elevate the lower extremities. Rationale: Elevation of the extremities several times daily is recommended to ease dependent edema. A- Fluid intake should be encouraged because adequate hydration maintains fluid and electrolyte balance. B- The client should not maintain a high-sodium diet because of the fluid retention. Sodium intake should be limited, but not completely restricted, because it is necessary to balance the increased fluid volume needs during pregnancy. D- Diuretics can be harmful and are not used during a healthy pregnancy.

Using the 5-digit system, determine the obstetric history in this situation: The client is 38 weeks into her fourth pregnancy. Her third pregnancy, a twin gestation, ended at 32 weeks with a live birth, her second pregnancy ended at 38 weeks with a live birth, and her first pregnancy ended at 18 weeks. A. G4, T2, P1, A1, L2 B. G4, T1, P2, A1, L1 C. G4, T1, P1, A1, L3 D. G4, T2, P1, A1, L1

ANS: C G4, T1, P1, A1, L3 Rationale: Four pregnancies= G (gravida) 4. One pregnancy that ended at 38 weeks = T (term) 1. One pregnancy that ended at 32 weeks = P (preterm) 1. One pregnancy that ended at 18 weeks = A (abortion) 1. One set of twins and a singleton = L (living) 3.

Which factor is frequently associated with hyperemesis gravidarum? A. History of cholecystitis B. Large amount of amniotic fluid C. High level of chorionic gonadotropin D. Decreased secretion of gastric acid

ANS: C High level of chorionic gonadotropin Rationale: A high level of chorionic gonadotropin is frequently associated with severe vomiting during pregnancy and may result in hyperemesis gravidarum. A high level may also occur in the presence of a hydatidiform mole or multiply pregnancy. A- Cholecystitis is unrelated to this problem. B- Hydramnios (excessive amniotic fluid) is associated with multiple gestations and some fetal abnormalities. D- There are no data to indicate that there is decreased gastric acid secretion during the first trimester, and this is not the cause of hyperemesis gravidarum.

Which would the nurse assess for in pregnant women who present with signs of physical abuse or neglect? A. Alcohol abuse B. Substance abuse C. Human trafficking D. Occupational activities

ANS: C Human trafficking Rationale: Nurses would assess for human trafficking in women who present with signs of physical abuse or neglect, such as scarring, bruises, burns, bald patches, or tattoos. A & B- Women who abuse alcohol or use substances do not usually present with signs of physical abuse or neglect. D- Occupational activities do not result in signs of physical abuse or neglect.

Which suggestion would the nurse make regarding what a client would wear to prevent back pain as pregnancy progresses? A. Maternity girdle B. Support stockings C. Low-heeled shoes D. Loose-fitting clothing

ANS: C Low-heeled shoes Rationale: Low-heeled supportive shoes help maintain the body's center of gravity over the hips, limiting arch of the back that compensates for the increased weight in the abdominal area. A- Maternity girdles are no longer recommended. B- Support stockings may be helpful for a woman with varicose veins or ankle edema; however, wearing them does not prevent back pain. D- Loose-fitting clothing is more comfortable but has no effect on back pain.

A client who is at 13 weeks' gestation arrives at the emergency department. She states that she began to have spotting and a small amount of vaginal bleeding several hours ago. This is her second pregnancy. Which gravidity would the nurse record? A. Multipara B. Primipara C. Multigravida D. Primigravida

ANS: C Multigravida Rationale: A multigravida is a woman who had more than one pregnancy. A- A multipara is a woman who has had two or more viable infants. B- A primipara is a woman who has had one viable infant. D- A primigravida is a woman who is pregnant for the first time.

Which condition is detected by an alpha-fetoprotein test? A. Kidney defects B. Cardiac anomalies C. Neural tube defects D. Urinary tract anomalies

ANS: C Neural tube defects Rationale: The alpha-fetoprotein test detects neural tube defects, Down Syndrome, and other congenital anomalies. It is a screening test that affords a tentative diagnosis; confirmation requires more definitive testing. Anomalies of the kidneys, heart, and urinary tract are not revealed by the alpha-fetoprotein test.

Which instruction would the nurse include when teaching episiotomy care? A. Rest with legs elevated at least 2 times a day. B. Avoid stair climbing for several days after discharge. C. Perform perineal care after toileting until healing occurs. D. Continue sitz baths 3 times a day if they provide comfort.

ANS: C Perform perineal care after toileting until healing occurs. Rationale: Performing perineal care after toileting until the episiotomy is healed is critical to the prevention of infection, which is at the core of episiotomy care. A- Resting is encouraged to promote involution and general recovery from childbirth. B- Stair climbing may cause some discomfort but is not detrimental to healing. D- There is no limit to the number of sitz baths per day that the client may take if they provide comfort.

Which effect does the nurse expect after an amniotomy is performed on a client in active labor? A. Diminished vaginal bleeding B. Less discomfort with contractions C. Progressive dilation and effacement D. Increased maternal and fetal heart rates.

ANS: C Progressive dilation and effacement Rationale: Amniotomy permits more effective pressure of the fetal head on the cervix, enhancing dilation and effacement. A- Vaginal bleeding may increase because of the progression of labor. B- Discomfort may increase because contractions usually become more intense after amniotomy. D- Amniotomy should not affect maternal and fetal heart rates.

Which laboratory test is conducted during the initial prenatal visit? Select all that apply. A. 1-hour glucose tolerance test B. 3-hour glucose tolerance test C. Cervical culture for Neisseria gonorrhoeae D. Chest x-ray for a positive tuberculosis skin test (TST) E. Group beta streptococcus (GBS) vaginal and anal cultures

ANS: C Rationale: During the initial prenatal visit, a cervical culture for N. gonorrhoeae is obtained. A- 1-hour glucose tolerance test B- A 3-hour glucose tolerance test is completed if a pregnant client fails the 1-hour glucose tolerance test. D- A chest x-ray is required after 20 weeks of gestation if the client has a positive TST. E- Vaginal and anal cultures for GBS are obtained at 35 to 37 weeks of gestation.

Which client statement indicates understanding of teaching about a nonstress test? A."I'll need to have an intravenous (IV) line so the medication can be injected before the test." B. "My baby may get very restless after I have this test." C. "I hope this test doesn't cause my labor to start too early." D. "If the heart reacts well, my baby should do OK when I give birth."

ANS: D "If the heart reacts well, my baby should do OK when I give birth." Rationale: The nonstress test is used to evaluate the response of the fetus to movement and activity. A reactive test indicates that the fetus is healthy. A- No injections of any kind are used during a nonstress test; it involves only the use of a fetal monitor to record the fetal heart rate during periods of activity. B- The nonstress test will not influence the activity of the fetus because no exogenous stimulus is used. C- Early labor is unlikely because the nonstress test is noninvasive.

A client whose weight was average for her height before becoming pregnant expresses concern about her 15-lb (6.8-kg) weight gain at only 23 weeks of pregnancy. What is an appropriate response?

ANS: D "Your weight is as expected for someone at 23 weeks' gestation, so continue with your current diet."

Which lecithin/sphinogomyelin (L/S) ratio is indicative of fetal lung maturity? A. 1 : 1 B. 1 : 4 : 1 C. 1 : 8 : 1 D. 2 : 1

ANS: D 2 : 1 Rationale: The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine the degree of fetal lung maturity, or the ability of the lungs to function after birth. Lecithin (L) is the most critical alveolar surfactant required for postnatal lung expansion. It is detectable at approximately 21 weeks and increases after week 24. Another pulmonary phospholipid, sphingomyelin (S), remains constant in amount. The measure of lecithin in relation to sphingomyelin, or the L/S ratio, is used to determine fetal lung maturity. When the L/S ratio reaches 2:1, the fetus' lungs are considered mature. The other ratios are incorrect.

An increase in which hormone can precipitate nausea and vomiting during the first trimester of pregnancy? A. Estrogen B. Progesterone C. Luteinizing hormone D. Chorionic gonadotropin

ANS: D Chorionic gonadotropin Rationale: Chorionic gonadotropin, secreted in large amounts by the placenta during gestation, and the metabolic changes associated with pregnancy can precipitate nausea and vomiting in early pregnancy; usually the manifestations of morning sickness disappear after the first trimester. A & B- Estrogen and progesterone are increased throughout pregnancy, but neither is the cause of the nausea and vomiting. C- Luteinizing hormone is present only during ovulation.

Which direction would the nurse give a client in preparation for ultrasonography at the end of her first trimester? A. Empty her bladder B. Avoid eating for 8 hours C. Take a laxative the night before the test. D. Increase fluid intake for 1 hour before the procedure.

ANS: D Increase fluid intake for 1 hour before the procedure. Rationale: In the first trimester, when fluid fills the bladder, the uterus is pushed up toward the abdominal cavity for optimum ultrasound viewing. A- The bladder must be full, not empty, for better visualization of the uterus. B- The gastrointestinal tract is not involved in ultrasound preparation, so directing the client to not eat for 8 hours before the test or to take a laxative would not be appropriate.

On arriving in the birthing room the nurse finds the client lying on her back with her head on a pillow and the bed in a flat position. The nurse explains that it is important to avoid lying in the supine position because of which reason? A. It may precipitate a severe headache. B. It can impede the progression of labor. C. It may cause nausea as labor progresses. D. It will prevent adequate blood flow to the fetus.

ANS: D It will prevent adequate blood flow to the fetus. Rationale: When the pregnant woman lies supine, pressure of the uterus against the vena cava reduces circulation; decreased perfusion of the placenta results in the decreased blood flow to the fetus. A- The supine position should not precipitate a headache, although it can lead to supine hypotension. B- Although the supine position can prolong labor, it is not the primary reason for a position change. C- As labor progresses toward the transition phase, nausea may occur; this is unrelated to the client's position.

Which sign or symptom would the nurse instruct a client at 29 weeks' gestation to report immediately to the primary care provider? A. Lower back pain B. White vaginal discharge C. Irregular strong contractions D. Leakage of fluid from the vagina

ANS: D Leakage of fluid from the vagina Rationale: Leakage may indicate rupture of the amniotic membranes; the client is at risk for an ascending infection from the vagina if birth does not occur within 24 hours or if early treatment is not instituted. A- Lower back pain is a common discomfort of pregnancy because the enlarged uterus causes a shift in the client's center of gravity. B- Leukorrhea is common during pregnancy because of increased vascularity of the cervix and increased production of mucus. C- Preparatory (Braxton-Hicks) contractions occur at irregular intervals throughout pregnancy; they become stronger after the 28th week of gestation.

Information about which factor can be obtained by means of an amniocentesis done during the 16th week of gestation? A. Lung maturity B. Type 1 diabetes C. Cardiac anomaly D. Neural tube defect

ANS: D Neural tube defect Rationale: Alpha-fetoprotein in amniotic fluid is increased in the presence of a neural tube defect. Lung maturity cannot be determined until after 35 weeks' gestation. Neither diabetes nor cardiac disorders can be detected with the use of amniocentesis.

Which physiological changes would the nurse anticipate after an amniotomy is performed? A. Diminished bloody show B. Increased and more variable fetal heart rate C. Less discomfort with contractions D. Progressive dilation and effacement

ANS: D Progressive dilation and effacement Rationale: Artificial rupture of the membranes (amniotomy() allows more effective exertion of pressure of the fetal head on the cervix, enhancing dilation and effacement. A- Vaginal bleeding (bloody show) may increase because of the progression of labor. B- Amniotomy does not directly affect the fetal heart rate. C- Discomfort may become greater because contractions usually increase in intensity and frequency after the membranes are artificially ruptured.

Which clinical finding during labor induction requires the nurse to discontinue the oxytocin infusion? A. Contractions occurring every 3 minutes and lasting 60 seconds B. Elevation of blood pressure from 110/70 to 135/85 mm Hg over 30 minutes C. Rupture of membranes with amniotic fluid that contains threads of blood and mucus D. Several late fetal heart rate decelerations that return to baseline after the contraction is over.

ANS: D Several late fetal heart rate decelerations that return to baseline after the contraction is over. Rationale: Late decelerations suggest uteroplacental insufficiency, which is an indication that the oxytocin infusion should be stopped. Continuing the infusion may compromise the status of the fetus. A- Contractions that occur every 3 minutes and last 60 seconds are within acceptable parameters; they require continued monitoring, and the infusion of oxytocin may be continued. B & C- An increase in blood pressure from 110/70 to 135/85 mm Hg during the past 30 minutes or rupture of the membranes requires continued monitoring but does not make it necessary for the infusion of oxytocin to be stopped.

The nurse is conducting the admission assessment of a client who is positive for group B streptococcus (GBS). Which finding is of concern to the nurse? A. Continued bloody show B. Cervical dilation of 4 cm C. Contractions every 4 minutes D. Spontaneous rupture of membranes 3 hours ago

ANS: D Spontaneous rupture of membranes 3 hours ago Rationale: Rupture of the membranes before intrapartum treatment of GBS increases the chances that infection will ascend into the uterus. GBS infection is a leading cause of neonatal morbidity and mortality. Continued bloody show, cervical dilation of 4 cm, and contractions every 4 minutes are all normal findings for a client in labor.

Which result after 20 minutes of a nonstress test is suggestive of fetal reactivity? A. Absence of long-term variability B. Above-average fetal baseline heart rate of 160 beats/min C. No late decelerations associated with contractions. D. Two accelerations of 15 beats/min lasting 15 seconds

ANS: D Two accelerations of 15 beats/min lasting 15 seconds Rationale: According to the American Congress of Obstetricians and Gynecologists, fetal reactivity is a fetal tracing 15 beats' acceleration above baseline lasting 15 seconds or more, normal baseline rate, and long-term variability amplitude of 10 or more beats/min. A- An absence of long-term variability is an ominous sign that must be addressed. B- An above-average baseline heart rate is acceptable up to 160 beats/min. An increasing baseline heart rate is a sign of maternal Infection. C- Contractions are not expected with a nonstress test; early, late, or variable fetal heart rate decelerations are associated with uterine contractions.

Fetal monitor strip picture question

Rationale: The NST is used to compare fetal heart accelerations with fetal movement. This strip shows adequate fetal heart rate variability, and the heart rate accelerates with fetal movement, which is reassuring. Contractions are NOT a component of an NST! The strip shows adequate fetal heart rate variability, so it is not nonreassuring. A positive NST indicates decelerations of the fetal heart rate with uterine contractions.