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.”.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Early decelerations in the fetal heart rate (FHR) are caused by compression of the fetus’s head during a uterine contraction. This often happens during later stages of labor as the baby is descending through the birth canal. They may also occur during early labor if the baby is premature or in a breech position. This causes the uterus to squeeze the head during contractions.
Choice B rationale
Uteroplacental insufficiency is a condition where the placenta does not provide enough oxygen and nutrients to the fetus. This condition is typically associated with late decelerations in the FHR, not early decelerations.
Choice C rationale
Altered fetal cerebral blood flow is not typically associated with early decelerations in the FHR34.
Choice D rationale
Umbilical cord compression is typically associated with variable decelerations in the FHR, not early decelerations.
Correct Answer is D
Explanation
Choice A rationale
Intermittent abdominal pain following passage of bloody mucus is more commonly associated with labor or conditions like bloody show but not specifically indicative of placenta previa.
Choice B rationale
Increasing abdominal pain with a non-relaxed uterus could be a sign of conditions such as uterine rupture or contractions, but it is not a typical sign of placenta previa. In placenta previa, the uterus is typically soft and non-tender.
Choice C rationale
Abdominal pain with scant red vaginal bleeding could be indicative of several conditions, including early labor or placental abruption, but it is not a typical sign of placenta previa. Placenta previa is usually characterized by painless bleeding.
Choice D rationale
Painless red vaginal bleeding is a classic sign of placenta previa. This occurs because the placenta, which is implanted low in the uterus, near or over the cervical os, begins to separate as the cervix effaces and dilates, leading to bleeding.
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