A nurse in a prenatal clinic is caring for a client who believes that she might be pregnant because she feels the baby moving. Which of the following statements should the nurse make?
"This is a probable sign of pregnancy."
"This is a possible sign of pregnancy."
"This is a positive sign of pregnancy."
"This is a presumptive sign of pregnancy."
The Correct Answer is D
Explanation:
A. "This is a probable sign of pregnancy."
A probable sign of pregnancy is an objective finding observed by a healthcare provider that suggests the likelihood of pregnancy but does not confirm it definitively. Examples of probable signs include positive pregnancy tests (urine or blood tests), changes in the uterus (enlargement, softening), and changes in the cervix (Goodell's sign, Chadwick's sign). Sensations of fetal movement, such as the feeling of the baby moving, are actually presumptive signs of pregnancy rather than probable signs because they can have other explanations and are not definitive proof of pregnancy.
B. "This is a possible sign of pregnancy."
While sensations of fetal movement can be associated with pregnancy, they are more accurately classified as presumptive signs rather than possible signs. Possible signs typically refer to signs or symptoms that could be related to various conditions, including pregnancy, but do not specifically indicate pregnancy on their own. In this context, "possible" may not be as accurate as "presumptive" for describing fetal movement as a sign of pregnancy.
C. "This is a positive sign of pregnancy."
A positive sign of pregnancy is a definitive finding that confirms the presence of a fetus. Examples of positive signs include fetal heartbeat heard by Doppler or ultrasound, fetal movement felt by the healthcare provider (palpation), and visualization of the fetus on ultrasound. Sensations of fetal movement reported by the woman (quickening) are not considered positive signs because they can be subjective and may have other explanations, such as gas or muscle contractions.
D. "This is a presumptive sign of pregnancy."
A presumptive sign of pregnancy is a subjective sign reported by the woman that may indicate pregnancy but can also have other explanations. Examples include amenorrhea (missed periods), nausea and vomiting (morning sickness), breast changes, and sensations of fetal movement (quickening). Sensations of fetal movement are considered presumptive because they are subjective and can be caused by factors other than pregnancy, such as gas or muscle contractions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Explanation:
A. "The baby's heart beat is audible by a Doppler stethoscope at 12 weeks of pregnancy."
This statement is correct. Around 12 weeks of pregnancy, the baby's heartbeat becomes audible using a Doppler stethoscope. This is a significant milestone in prenatal care as it allows healthcare providers and expectant parents to hear the baby's heartbeat for the first time, providing reassurance about fetal well-being.
B. "Very fine hairs, called lanugo, cover your baby's entire body by week 36 of pregnancy."
This statement is incorrect. Lanugo, the fine hair covering the baby's body, typically appears much earlier in pregnancy, around 20 weeks. However, it usually starts to shed during the third trimester, and by week 36, the baby may have minimal or no lanugo remaining. Therefore, stating that lanugo covers the entire body by week 36 is inaccurate.
C. "The sex of the baby is determined by week 8 of pregnancy."
This statement is incorrect. The sex of the baby is determined at conception when the sperm fertilizes the egg. However, the external genitalia are not typically visible on ultrasound until around week 16 to 20 of pregnancy. Therefore, while the genetic sex is determined early, it may not be visualized or confirmed until later in pregnancy.
D. "You will first feel your baby move in week 24 of pregnancy."
This statement is incorrect. Most women begin to feel fetal movements, also known as quickening, between weeks 16 and 25 of pregnancy. The first movements are typically felt around weeks 18 to 20, rather than specifically at week 24. Therefore, stating that the first fetal movements are felt at week 24 is not accurate.
Correct Answer is C
Explanation
Explanation:
A. "You will need to double your intake of iron during pregnancy."
This statement is not accurate. While iron needs do increase during pregnancy to support the increased blood volume and fetal development, the recommended increase is not necessarily a doubling of intake. Specific iron requirements can vary based on individual factors, such as pre-pregnancy iron status and maternal health conditions.
B. "Prenatal vitamins will meet your need for increased vitamin D during pregnancy."
Prenatal vitamins typically contain some vitamin D, but they may not meet the increased need for vitamin D during pregnancy entirely, especially if the client has limited sun exposure or other risk factors for vitamin D deficiency. Additional sources of vitamin D, such as sunlight exposure and dietary sources, may be recommended.
C. "You will need to increase your calcium intake during breastfeeding."
This statement is correct. During breastfeeding, calcium requirements increase to support milk production and the maintenance of maternal bone health. Adequate calcium intake is important for both the mother and the growing infant.
D. "Vitamin E requirements decline during pregnancy due to the increase in body fat."
This statement is not accurate. Vitamin E requirements do not necessarily decline during pregnancy because of an increase in body fat. Vitamin E is still essential during pregnancy for its antioxidant properties and role in fetal development.
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