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A patient 11 weeks' gestation comes to the emergency room department with c/o dizziness, abdominal pain, and shoulder pain. Lab tests reveal a beta-hcg lower than expected level for gestational age
- A. Ultrasound confirms no intrauterine
- B. The nurse knows the most likely diagnostic is an ectopic pregnancy. What statement should the nurse use to explain to the patient?
- C. The baby is in the fallopian tube, the tube has ruptured and is causing bleeding
Correct Answer: B
Rationale: Step 1: Recognize Symptoms - Dizziness, abdominal pain, shoulder pain, low beta-hcg.
Step 2: Consider Ectopic Pregnancy - Symptoms align with ectopic pregnancy.
Step 3: Rule Out Miscarriage - Low beta-hcg indicates not viable intrauterine pregnancy (Choice A).
Step 4: Understand Ectopic Pregnancy - Explaining ectopic pregnancy (Choice C) and rupture to patient may cause distress.
Step 5: Communicate - Nurse should use simple, empathetic statement (Choice B) to explain the likely diagnosis.
Summary: Choice B is correct as it addresses the likely diagnosis without causing undue distress to the patient, unlike Choices A and C which may lead to confusion and anxiety.
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The nurse is educating a client about postpartum warning signs. Which symptom requires immediate medical attention?
- A. Increased lochia after breastfeeding.
- B. Perineal discomfort on day 3 postpartum.
- C. Fever of 101°F and foul-smelling lochia.
- D. Mild fatigue and trouble sleeping.
Correct Answer: C
Rationale: The correct answer is C: Fever of 101°F and foul-smelling lochia. This combination indicates a possible infection like endometritis, which can be life-threatening if not promptly treated. Fever is a sign of systemic infection, and foul-smelling lochia suggests an infected uterus. Immediate medical attention is crucial to prevent complications.
A: Increased lochia after breastfeeding is common and not necessarily alarming unless it is excessive or accompanied by other symptoms.
B: Perineal discomfort on day 3 postpartum is expected due to the healing process and does not typically require immediate medical attention.
D: Mild fatigue and trouble sleeping are common postpartum symptoms but do not indicate a medical emergency unless they are severe or persistent.
The nurse is assessing a client at 10 weeks' gestation with hyperemesis gravidarum. What is the priority nursing action?
- A. Encourage small, frequent meals.
- B. Monitor for signs of dehydration.
- C. Administer antiemetics as prescribed.
- D. Encourage fluid intake between meals.
Correct Answer: B
Rationale: The correct answer is B: Monitor for signs of dehydration. Dehydration is a serious complication of hyperemesis gravidarum and can lead to electrolyte imbalances and maternal-fetal complications. By monitoring for signs of dehydration, the nurse can intervene promptly to prevent further complications. Encouraging small, frequent meals (choice A) may help manage nausea but does not address the risk of dehydration. Administering antiemetics (choice C) may be necessary, but monitoring for dehydration takes precedence. Encouraging fluid intake between meals (choice D) is important, but assessing for dehydration is more critical in this situation.
A nurse is a prenatal clinic is completing a skin assessment for a pregnant client in the second trimester. Which clinical findings should the nurse expect (select all that apply)?
- A. Eczema
- B. Psoriasis C.Linea nigra
- C. Chloasma
- D. Striae gravidarum C, D, E
Correct Answer: C
Rationale: The correct answer is C: Linea nigra. During the second trimester of pregnancy, hormonal changes can lead to the development of Linea nigra, a dark vertical line that appears on the abdomen. This is a common skin change in pregnant women.
Explanation:
1. Eczema (choice A) and Psoriasis (choice B) are chronic skin conditions that are not typically associated with pregnancy. These conditions are not expected findings during the second trimester.
2. Chloasma (choice C) is also known as the "mask of pregnancy" and presents as dark patches on the face. This is a common skin change during pregnancy, especially in the second trimester.
3. Striae gravidarum (choice D) are stretch marks that may develop on the abdomen, breasts, and thighs during pregnancy. While this is a common skin change in pregnancy, it is not one of the expected findings in the second trimester according to the question.
In summary, the correct
Preexisting medical conditions like diabetes, hypertension, and autoimmune diseases can impact pregnancy outcomes. What education can the nurse provide?
- A. Your medical condition always gets worse during pregnancy.
- B. Nutrition changes cannot help with fertility.
- C. Maintaining glucose control can increase chances of conceiving.
- D. Autoimmune diseases only affect pregnancy, not infertility.
Correct Answer: C
Rationale: The correct answer is C: Maintaining glucose control can increase chances of conceiving. This is because uncontrolled diabetes can lead to complications during pregnancy, affecting both the mother and the baby. By educating the patient on the importance of managing their glucose levels, the nurse can help improve fertility outcomes.
A: Your medical condition always gets worse during pregnancy - Incorrect. Medical conditions may not always worsen during pregnancy, and managing them properly can lead to positive outcomes.
B: Nutrition changes cannot help with fertility - Incorrect. Nutrition plays a crucial role in fertility, and making appropriate dietary changes can improve the chances of conception.
D: Autoimmune diseases only affect pregnancy, not infertility - Incorrect. Autoimmune diseases can impact fertility as well as pregnancy outcomes, so it is important to address these conditions when trying to conceive.
The nurse would classify a newborn delivered at 39 weeks' gestation, weighing 2400 g ( 5.0 lbs) as being:
- A. Preterm and immature
- B. Small-for-gestational age
- C. Average-for-gestational age
- D. Average-for-gestational age but pre-term
Correct Answer: B
Rationale: The correct answer is B: Small-for-gestational age. A newborn delivered at 39 weeks' gestation and weighing 2400g is considered small-for-gestational age because the weight is below the 10th percentile for the gestational age. This indicates intrauterine growth restriction. Preterm and immature (choice A) would not apply as the baby was delivered at term. Average-for-gestational age (choice C) would not be accurate as the baby's weight is below the normal range for that gestational age. Choice D is also incorrect as the baby is not within the average weight range for the gestational age.