A nurse in a prenatal clinic is caring for a client who reports that her menstrual period is 2 weeks late. The client appears anxious and asks the nurse if she is pregnant. Which of the following responses should the nurse make?
"You can miss your period for several other reasons. Describe your typical menstrual cycle
"If you have been sexually active and haven't used protection it is likely that you are pregnant
"Let's check to see if you have any other signs of pregnancy. Have you noticed any abdominal enlargement yet?
"Because you have missed your period, you should try taking a home pregnancy test before you start worrying
The Correct Answer is A
Choice A Reason:
"You can miss your period for several other reasons. Describe your typical menstrual cycle." This response acknowledges that a missed period can result from various factors other than pregnancy, such as stress, changes in weight, hormonal fluctuations, or certain medical conditions. Understanding the client's typical menstrual cycle can help the nurse gather more information about potential reasons for the late period.
Choice B Reason:
"If you have been sexually active and haven't used protection, it is likely that you are pregnant. “This response assumes pregnancy without exploring other possibilities or the client's individual situation.
Choice C Reason:
"Let's check to see if you have any other signs of pregnancy. Have you noticed any abdominal enlargement yet?" While considering other signs of pregnancy is reasonable, focusing on abdominal enlargement may not be the most accurate early indicator, and it's essential to explore a broader range of symptoms.
Choice D Reason:
"Because you have missed your period, you should try taking a home pregnancy test before you start worrying. "While suggesting a home pregnancy test is reasonable, it may be more beneficial to gather additional information about the client's menstrual cycle and potential symptoms before jumping directly to a test.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
a.Panting helps to control the urge to push and can slow down the delivery, which is important to prevent rapid delivery that could cause injury to both the mother and the baby. It allows the nurse or healthcare provider to better manage the delivery process.
b.Slow-paced breathing is often used during early labor to help manage pain and anxiety. However, when the baby’s head is crowning, panting is more effective in controlling the urge to push and slowing down the delivery process.
c.While deep cleansing breaths can be helpful during contractions to manage pain and focus, they are not as effective as panting in controlling the urge to push during the crowning phase.
d.While it might seem natural to encourage pushing when the baby’s head is crowning, it’s important to control the delivery to prevent rapid birth, which can cause injury to both the mother and the baby. Encouraging the mother to pant helps slow down the process, allowing for a more controlled and safer delivery.
Correct Answer is A
Explanation
Choice A Reason:
"You should take the medication within 72 hours following unprotected sexual intercourse." This statement is accurate. Levonorgestrel is an emergency contraceptive that is effective when taken within 72 hours (3 days) after unprotected sexual intercourse. It is crucial to use it as soon as possible for optimal effectiveness in preventing pregnancy.
Choice B Reason:
"You should avoid taking this medication if you are on an oral contraceptive." This statement is not accurate. Levonorgestrel can be used as emergency contraception, even if the individual is already on an oral contraceptive. However, it's essential to follow the healthcare provider's guidance.
Choice C Reason:
"If you don't start your period within 5 days of taking this medication, you will need a pregnancy test." This statement is not entirely accurate. While a delayed period may occur after taking levonorgestrel, it does not necessarily indicate pregnancy. If there are concerns about pregnancy, a pregnancy test should be taken a few weeks after using emergency contraception.
Choice D Reason:
"One dose of this medication will prevent you from becoming pregnant for 14 days after taking it." This statement is not accurate. Levonorgestrel is primarily effective in the prevention of pregnancy when taken shortly after unprotected intercourse. It does not provide ongoing protection, and additional contraceptive methods should be considered for future encounters.
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