A client is admitted with a threatened abortion. Which assessment findings would the nurse expect? Select all that apply. (Select All that Apply.)

Passage of fetal tissue

Bright red vaginal bleeding

Severe cramping and pelvic pain

Closed cervix upon examination

Mild to moderate lower abdominal cramping

Answer and Explanation

Correct Answer : B,D,E

A. Passage of fetal tissue – This finding is more consistent with an incomplete or complete abortion, not a threatened abortion.

B. Bright red vaginal bleeding – A threatened abortion involves vaginal bleeding during the first 20 weeks of pregnancy, often bright red in color. The cervix remains closed, and fetal cardiac activity may still be present.

C. Severe cramping and pelvic pain – Severe pain is more typical of an inevitable or incomplete abortion rather than a threatened abortion.

D. Closed cervix upon examination – In a threatened abortion, the cervix remains closed. If the cervix opens, the risk of progressing to an inevitable abortion increases.

E. Mild to moderate lower abdominal cramping – Mild cramping or lower abdominal discomfort is common in a threatened abortion due to uterine contractions. However, severe cramping and passage of fetal tissue would indicate a more advanced pregnancy loss.

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Correct Answer is ["B","C","E"]

Explanation

A. Penicillin
Penicillin is an antibiotic used for bacterial infections, not viral infections like HSV-2. Herpes simplex virus requires antiviral medications such as acyclovir, valacyclovir, or famciclovir for symptom management.

B. Perineal care of genital lesions
Proper perineal care helps prevent secondary infections and promotes healing. The client should be advised to keep the area clean and dry, avoid irritating soaps, and wear loose-fitting clothing.

C. Use of barrier protection
Consistent use of barrier protection (e.g., condoms) reduces the risk of transmitting HSV-2 to sexual partners. The client should be educated that HSV-2 can be transmitted even when lesions are not visible due to asymptomatic viral shedding.

D. Gardasil injection
Gardasil is a vaccine that protects against certain strains of Human Papillomavirus (HPV), not HSV-2. While both HSV-2 and HPV are sexually transmitted infections, they are caused by different viruses and require different preventive measures.

E. Hand washing
Proper hand hygiene prevents the spread of HSV-2 from touching lesions and transferring the virus to other body areas or individuals. Clients should be advised to wash hands thoroughly after touching affected areas.

A. Fetal heart rate (FHR) B. Bowel sounds C. Respiratory rate D. Temperature

Correct Answer is C

Explanation

A. Fetal heart rate (FHR): While FHR monitoring is important, the priority is assessing the mother's respiratory status due to the risk of magnesium toxicity, which can lead to respiratory depression.

B. Bowel sounds: Magnesium sulfate can cause decreased gastrointestinal motility, but bowel sounds are not the immediate priority. The nurse should monitor for paralytic ileus, but respiratory function takes precedence.

C. Respiratory rate: Magnesium sulfate is a central nervous system (CNS) depressant that can cause respiratory depression if levels become too high. A respiratory rate below 12 breaths per minute is a sign of magnesium toxicity, requiring immediate intervention (e.g., stopping the infusion and administering calcium gluconate).

D. Temperature: Temperature is not directly affected by magnesium sulfate administration, making it a lower-priority assessment compared to respiratory rate.

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A client is admitted with a threatened abortion. Which assessment findings would the nurse expect? Select all that apply. (Select All that Apply.)

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Naxlex Comprehensive Predictor Exams

A teenager presents to the clinic with complaints of painful lesions, fever, headache, and vaginal discharge. After testing she is diagnosed with Herpes simplex virus type 2. What education should the nurse include in a teaching plan? (Select All that Apply.)

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Explanation

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Explanation

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