A client with hyperemesis gravidarum is admitted to the facility after being cared for at home without success. What would the nurse expect to include in the client's plan of care?
clear liquid diet
administration of diethylstilbestrol
total parenteral nutrition
nothing by mouth
The Correct Answer is C
Choice A: A clear liquid diet is not appropriate for a client with hyperemesis gravidarum, which is a severe form of nausea and vomiting during pregnancy that can lead to dehydration, electrolyte imbalance, and weight loss. A clear liquid diet does not provide adequate calories, protein, vitamins, or minerals for the client and the fetus.
Choice B: Administration of diethylstilbestrol is not indicated for a client with hyperemesis gravidarum. Diethylstilbestrol is a synthetic estrogen that was used in the past to prevent miscarriage and premature birth, but it was found to cause serious adverse effects such as vaginal cancer, infertility, and birth defects in the offspring.
Choice C: Total parenteral nutrition is the correct choice because it provides a complete and balanced source of nutrients through a central venous catheter. It is used for clients who cannot tolerate oral or enteral feeding due to severe gastrointestinal disorders such as hyperemesis gravidarum. It helps to prevent malnutrition, dehydration, and ketosis in the client and the fetus.
Choice D: Nothing by mouth is not a suitable option for a client with hyperemesis gravidarum. It can worsen the condition by causing starvation, acidosis, and ketosis. It can also increase the risk of aspiration pneumonia if the client vomits.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason: This is incorrect because wearing spandex-type full-length pants can constrict the blood flow and increase the swelling in the feet. The nurse should advise the woman to wear loose-fitting clothes and comfortable shoes that do not squeeze or rub her feet.
Choice B Reason: This is correct because elevating the legs when sitting can improve venous return and reduce the swelling in the feet. The nurse should encourage the woman to elevate her legs above her heart level whenever possible and avoid crossing her legs or standing for long periods.
Choice C Reason: This is incorrect because limiting the intake of fluids can cause dehydration and worsen the swelling in the feet. The nurse should recommend the woman drink plenty of water and other healthy fluids to maintain hydration and flush out excess sodium and waste products from her body.
Choice D Reason: This is incorrect because eliminating salt from the diet can cause electrolyte imbalance and affect the fluid balance in the body. The nurse should advise the woman to consume salt in moderation and avoid processed foods that are high in sodium.
Correct Answer is B
Explanation
Choice A Reason: This is incorrect because ambivalence is a mixed or contradictory feeling towards something or someone. It may occur in some women during pregnancy, especially if the pregnancy was unplanned or unwanted. However, it is not the most likely emotional response in the first trimester.
Choice B Reason: This is correct because emotional lability is a rapid and exaggerated change in mood or affect. It may occur in many women during pregnancy due to hormonal fluctuations, physical changes, and psychological stressors. Emotional lability may manifest as increased irritability, anxiety, sadness, or crying spells.
Choice C Reason: This is incorrect because introversion is a personality trait that indicates a preference for solitude and inward focus. It may be present in some women before or during pregnancy, but it is not an emotional response that is specific to the first trimester.
Choice D Reason: This is incorrect because acceptance is a positive attitude that indicates a willingness to embrace the reality of something or someone. It may develop in some women during pregnancy as they adjust to their new role and identity as mothers. However, it is not the most likely emotional response in the first trimester.
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