Nokea
Assessment of a pregnant woman reveals a pigmented line down the middle of her abdomen. The nurse documents this as which finding?
- A. striae gravidarum
- B. linea nigra
- C. vascular spiders
- D. melasma
Correct Answer: B
Rationale: Linea nigra is a dark line from umbilicus to pubis caused by increased melanin from hormonal changes. Striae gravidarum are stretch marks, vascular spiders are dilated vessels on face or chest, and melasma is facial pigmentation, none matching the abdominal line description.
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A nurse is planning a presentation about HIV for a church-based group. Which of the following information about HIV transmission should the nurse include?
- A. It is primarily transmitted through mosquitoes.
- B. It is primarily transmitted through accidental puncture wounds.
- C. It is primarily transmitted through sexual contact.
- D. It is primarily transmitted through respiratory droplets.
Correct Answer: C
Rationale: HIV is primarily transmitted through sexual contact involving infected fluids like semen or vaginal secretions. Mosquitoes, respiratory droplets, and puncture wounds (rare) don't commonly spread HIV.
During a vaginal exam, the nurse notes that the lower uterine segment is softened. The nurse documents this finding as:
- A. Ortolani's sign
- B. Chadwick's sign
- C. Goodell's sign
- D. Hegar's sign
Correct Answer: D
Rationale: Hegar's sign is softening of the lower uterine segment, felt early in pregnancy. Ortolani's tests infant hips, Chadwick's is cervical discoloration, and Goodell's is cervical softening, not uterine.
A client is suspected of having a ruptured ectopic pregnancy. Which assessment would the nurse identify as the priority?
- A. Hemorrhage
- B. Edema
- C. Infection
- D. Jaundice
Correct Answer: A
Rationale: A ruptured ectopic pregnancy causes internal bleeding, leading to hypovolemic shock, making hemorrhage the priority assessment. Edema, infection, or jaundice may occur later but are less urgent than life-threatening bleeding.
A nurse is assessing a client who may be pregnant. The nurse reviews the client's history for presumptive signs. Which signs would the nurse most likely note? Select all that apply.
- A. Nausea
- B. Abdominal enlargement
- C. Positive pregnancy test
- D. Braxton Hicks contractions
- E. Amenorrhea
Correct Answer: A,B,C,E
Rationale: Presumptive signs, subjective or non-definitive, include nausea (hormonal), abdominal enlargement (uterine growth), positive pregnancy test (hCG detection), and amenorrhea (missed periods). Braxton Hicks are probable signs, felt later.
A client's last menstrual period was April 11. Using Nägele's rule, her estimated date of birth (EDB) would be:
- A. 18-Feb
- B. 18-Jan
- C. 8-Jan
- D. 28-Dec
Correct Answer: B
Rationale: Nägele's rule: add 1 year, subtract 3 months, add 7 days. April 11, 2023 + 1 year = April 11, 2024; minus 3 months = January 11, 2024; plus 7 days = January 18, 2024. Other options misapply the rule.