A nurse in a prenatal clinic is caring for a client who believes she might be pregnant because she feels the baby moving.Which statement should the nurse make?

“This is a probable sign of pregnancy.”.

“This is a possible sign of pregnancy.”.

“This is a presumptive sign of pregnancy.”.

“This is a positive sign of pregnancy.”.

Answer and Explanation

The Correct Answer is C

Choice A rationale
A probable sign of pregnancy includes objective signs observed by an examiner, such as changes in the pelvic organs, enlargement of the abdomen, and positive pregnancy test.
Choice B rationale
Possible signs of pregnancy are those that are subjective and reported by the patient, such as nausea, vomiting, and missed period. These signs could be due to other conditions.
Choice C rationale
Feeling the baby moving, also known as quickening, is a presumptive sign of pregnancy. These are changes felt by the woman herself and can be caused by other conditions.
Choice D rationale
Positive signs of pregnancy are those that are confirmed by the examiner and cannot be caused by any other condition. These include hearing the fetal heartbeat, visualizing the fetus, and feeling the baby move.

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Correct Answer is C

Explanation

Choice A rationale
Elevating the client’s legs is not the first action to take. While it can help with circulation, it does not directly address the issue of late decelerations.
Choice B rationale
Administering oxygen using a nonrebreather mask can be beneficial as it can increase the amount of oxygen available to the fetus. However, it is not the first action to take.
Choice C rationale
Placing the client in the lateral position is the correct action. This position can help improve placental blood flow and potentially improve the oxygen supply to the fetus.
Choice D rationale
Increasing the rate of maintenance IV infusion is not the first action to take. While it can help maintain hydration and blood pressure, it does not directly address the issue of late decelerations.

A. “I will call your primary care provider to report your concerns.”. B. “This is a concern, but strabismus is easily treated with patching.”. C. “This occurs because newborns lack muscle control to regulate eye movement.”. D. “I will take your baby to the nursery for further examination.”. .

Correct Answer is C

Explanation

Choice A rationale
While it’s important to report concerns to the primary care provider, this does not directly address the mother’s concern about her newborn’s crossed eyes.
Choice B rationale
Strabismus is a condition where the eyes do not properly align with each other, but it is not the same as the normal crossing of a newborn’s eyes.
Choice C rationale
This is the correct answer. Newborns often lack the muscle control to regulate eye movement, which can cause their eyes to cross.
Choice D rationale
Taking the baby to the nursery for further examination may be necessary if there are other concerns, but it does not directly address the mother’s concern about her newborn’s crossed eyes.

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A nurse in a prenatal clinic is caring for a client who believes she might be pregnant because she feels the baby moving.Which statement should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A nurse is caring for a new mother who is worried about her newborn’s crossed eyes. Which of the following responses by the nurse would be therapeutic?

Correct Answer is C

Explanation

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