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A nurse in a prenatal clinic is reviewing the medical record of a client who is at 28 weeks of gestation. The client's history reveals one pregnancy terminated by elective abortion at 9 weeks; the birth of twins at 36 weeks; and a spontaneous abortion at 15 weeks of gestation. According to the GTPAL system, which of the following describes her present parity?

4-0-0-2-2

4-2-0-2-2

4-0-2-2-2

4-0-1-2-2

Answer and Explanation

The Correct Answer is D

G (Gravida) — Total number of pregnancies, including the current one.

Elective abortion at 9 weeks

Birth of twins at 36 weeks

Spontaneous abortion at 15 weeks

Current pregnancy at 28 weeks So, G = 4.

T (Term births) — Number of pregnancies carried to 37 weeks or beyond.

- She hasn't had any pregnancies reach full term. So, T = 0.

P (Preterm births) — Number of pregnancies delivered between 20 and 36 weeks.

- Twins born at 36 weeks. So, P = 1.

A (Abortions) — Number of pregnancies ending before 20 weeks (spontaneous or elective).

- Elective abortion at 9 weeks
- Spontaneous abortion at 15 weeks So, A = 2.

L (Living children) — Number of living children.

- The twins are living children. So, L = 2.

Putting it all together, her GTPAL notation is G4 T0 P1 A2 L2.

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Correct Answer is B

Explanation

b. Apply an external fetal monitor.

The nurse should apply an external fetal monitor to assess the fetal heart rate and activity, as well as the presence and intensity of contractions. Placenta previa is a condition where the placenta covers part or all of the cervical opening, which can cause painless, bright red bleeding in the third trimester. Placenta previa can compromise fetal oxygenation and perfusion, and can also trigger preterm labor. Therefore, the nurse should monitor the fetal well- being and readiness for delivery.

The other actions are not appropriate and may cause harm to the client or the fetus.

a. The nurse should not perform a rectal exam, as this can cause trauma or infection to the rectum or the placenta, and increase the risk of bleeding or rupture.

c. The nurse should not complete a vaginal exam, as this can dislodge or damage the placenta, and cause severe

hemorrhage or shock.

d. The nurse should not apply ice to the perineal area, as this can cause vasoconstriction and reduce blood ﬂow to the placenta and the fetus, and worsen their condition.

A. "What else have you been eating?" B. "Go to the emergency room and your provider will meet you there." C. "This is expected because of the way iron is broken down during digestion." D. "Come to the office and we will check things out."

Correct Answer is C

Explanation

c. "This is expected because of the way iron is broken down during digestion."

The client's stools are black because of the iron supplements, which can cause a harmless change in the color and consistency of the stools. This is due to the oxidation of iron in the gastrointestinal tract, which produces a black pigment called ferrous sulfide. This is not a sign of bleeding or infection and does not require further evaluation or treatment. The nurse should reassure the client that this is a normal side eﬀect of iron supplements and advise her to continue taking them as prescribed.

The other responses are not appropriate and may cause unnecessary anxiety or inconvenience for the client.

The nurse should not ask the client what else she has been eating, as this implies that her diet may be causing her stools to be black. This may confuse or oﬀend the client, who may think that the nurse is questioning her nutritional choices or blaming her for her condition.

The nurse should not tell the client to go to the emergency room, as this suggests that her stools are black because of a serious problem that needs immediate atention. This may frighten or alarm the client, who may think that she or her baby are in danger.

d. The nurse should not tell the client to come to the office, as this indicates that her stools are black because of an abnormal finding that needs further investigation. This may worry or inconvenience the client, who may think that she has a complication or infection that requires testing or treatment.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is at 34 weeks of gestation and has a suspected placenta previa. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is speaking on the phone to a client who is pregnant and taking iron supplements for iron-deficiency anemia. The client reports that her stools are black but she has no abdominal pain or cramping. Which of the following responses by the nurse is appropriate?

Correct Answer is C

Explanation

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