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A nurse is caring for a pregnant patient who is at 40 weeks gestation and is experiencing a sudden increase in vaginal discharge. What is the nurse's priority action?
- A. Check for signs of labor and assess fetal heart rate.
- B. Encourage the patient to rest and monitor for changes in discharge.
- C. Perform a pelvic exam to assess the amount of discharge.
- D. Call the healthcare provider immediately to report the change in discharge.
Correct Answer: A
Rationale: The correct answer is A because the sudden increase in vaginal discharge at 40 weeks gestation could indicate the onset of labor. Checking for signs of labor, such as contractions and assessing fetal heart rate, is crucial to determine if the patient is in active labor. This helps in timely intervention and ensuring the well-being of both the mother and baby.
Summary:
- Choice B: Encouraging rest and monitoring changes in discharge may not address the urgency of the situation.
- Choice C: Performing a pelvic exam without assessing signs of labor or fetal well-being may delay necessary actions.
- Choice D: While reporting to the healthcare provider is important, immediate assessment of labor signs and fetal heart rate takes precedence.
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A client makes the following statement after finding out that her pregnancy test is positive, 'This is not a good time. I am in college and the baby will be due during final exams!' Which of the following responses by the nurse would be most appropriate at this time?
- A. I’m absolutely positive that everything will turn out all right.
- B. I suggest that you e-mail your professors to set up an alternate plan.
- C. It sounds like you’re feeling a little overwhelmed right now.
- D. You and the baby’s father will find a way to get through the pregnancy.
Correct Answer: C
Rationale: Acknowledging the client's feelings of being overwhelmed is the most supportive response. Offering solutions or reassurance without first addressing the client's emotions may not be as effective.
A pregnant patient at 28 weeks gestation reports leg cramps and lower back pain. What should the nurse recommend to alleviate these symptoms?
- A. Take a warm bath and perform leg stretches to relieve muscle tension.
- B. Apply a heating pad to the affected areas and rest in bed.
- C. Increase calcium intake and take over-the-counter pain medications.
- D. Encourage the patient to perform light physical activity and avoid long periods of rest.
Correct Answer: A
Rationale: The correct answer is A. Leg cramps and lower back pain in pregnancy can be relieved by taking a warm bath and performing leg stretches. Warm water helps relax muscles, while stretching can alleviate muscle tension. This is safe and effective for pregnant patients.
Choice B is incorrect because applying a heating pad may not be recommended during pregnancy due to the risk of overheating. Resting in bed may provide temporary relief but does not address the underlying cause.
Choice C is incorrect because increasing calcium intake and taking over-the-counter pain medications may not specifically target muscle cramps and back pain. It is essential to address the symptoms directly.
Choice D is incorrect because encouraging light physical activity may be beneficial, but avoiding long periods of rest may not be necessary. Stretching and warm baths are more specific interventions for muscle cramps and back pain.
Which factors should be considered a contraindication for transcervical chorionic villus sampling?
- A. Rh-negative mother
- B. Gestation less than 15 weeks
- C. Maternal age younger than 35 years
- D. Positive for group B Streptococcus
Correct Answer: D
Rationale: Maternal infection, such as group B Streptococcus, is a contraindication for the procedure due to the risk of infection.
A pregnant patient is at 28 weeks gestation and is diagnosed with gestational diabetes. What is the most important aspect of the patient's care plan?
- A. Maintaining a healthy weight gain during pregnancy.
- B. Monitoring blood glucose levels and maintaining a balanced diet.
- C. Increasing fluid intake to reduce the risk of dehydration.
- D. Administering insulin to control blood sugar levels.
Correct Answer: B
Rationale: The correct answer is B: Monitoring blood glucose levels and maintaining a balanced diet. This is crucial for managing gestational diabetes, as it helps control blood sugar levels to prevent complications for both the mother and baby. Regular monitoring ensures timely adjustments to treatment. A balanced diet helps regulate blood sugar levels and provides essential nutrients for the baby's growth.
Choice A is important but not as critical as monitoring blood glucose levels, as weight gain should be monitored but is not the primary focus in gestational diabetes. Choice C is not directly related to managing gestational diabetes. Choice D may be necessary in some cases, but it is not the most important aspect of care compared to monitoring blood glucose levels and diet.
A nurse is providing prenatal education to a patient who is 22 weeks gestation. Which of the following topics should be emphasized at this stage of pregnancy?
- A. Signs and symptoms of preterm labor
- B. Signs of gestational diabetes
- C. Breastfeeding education
- D. Postpartum care
Correct Answer: A
Rationale: The correct answer is A: Signs and symptoms of preterm labor. At 22 weeks gestation, it is crucial to educate the patient about potential signs of preterm labor to help prevent premature birth and ensure the well-being of the baby. Symptoms such as regular contractions, abdominal cramping, backache, and vaginal bleeding should be discussed. This topic is time-sensitive and requires immediate action if observed.
Summary of other choices:
B: Signs of gestational diabetes - While important, monitoring for gestational diabetes typically occurs later in pregnancy, usually around 24-28 weeks.
C: Breastfeeding education - Important, but not as time-sensitive as preterm labor education.
D: Postpartum care - Relevant but more appropriate for later stages of pregnancy or after birth, not specifically at 22 weeks gestation.