A nurse at a provider's office is caring for a client.
Oxygen saturation
Vaginal spotting
Heart rate
Bowel sounds
Respiratory findings
Temperature
Abdominal findings
Menstrual period
Correct Answer : B,G,H
A. Oxygen saturation
Oxygen saturation is within normal range at 97%; no immediate follow-up is needed.
B. Vaginal spotting
In early pregnancy, dark red spotting with pain could indicate ectopic pregnancy or threatened abortion and requires immediate evaluation.
C. Heart rate
HR of 90/min is normal and stable, not a concern at this time.
D. Bowel sounds
Hyperactive bowel sounds are nonspecific and not immediately concerning without additional GI symptoms.
E. Respiratory findings
Lung sounds are only slightly diminished, with normal RR and SpO₂, so not urgent.
F. Temperature
37.3°C is within normal limits and does not require follow-up.
G. Abdominal findings
Right lower quadrant tenderness could indicate ectopic pregnancy, appendicitis, or PID and must be evaluated promptly.
H. Menstrual period
Missed period in combination with positive hCG and abdominal pain raises concern for ectopic pregnancy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Hypermagnesemia
Hypomagnesemia is more likely due to vomiting and malnutrition.
B. Amenorrhea
More typical in anorexia nervosa; less common in bulimia.
C. Tooth erosion
Frequent vomiting in bulimia leads to enamel erosion from gastric acid.
D. Hyperkalemia
Bulimia is often associated with hypokalemia due to purging.
Correct Answer is D
Explanation
A. Yellow sclera:
Yellow sclera suggests jaundice, not a common adverse effect of digoxin.
B. Bleeding gums:
This is not a typical sign of digoxin toxicity, but may relate to coagulopathies or poor dental hygiene.
C. Frequent swallowing:
While this may occur with nausea, it is not a primary indicator of digoxin toxicity.
D. Blurred vision:
Visual disturbances (such as blurred vision or seeing halos) are classic signs of digoxin toxicity.
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