A nurse in an antepartum unit is triaging clients. Which of the following clients should the nurse see first?

A client who is at 38 weeks of gestation and reports a cough and fever.

A client who has missed a period and reports vaginal spotting.

A client who is at 14 weeks of gestation and reports nausea and vomiting.

A client who is at 28 weeks of gestation and reports painless vaginal bleeding.

Answer and Explanation

The Correct Answer is D

A. A client at 38 weeks of gestation with a cough and fever may have an infection, which is concerning, but it is not immediately life-threatening. The nurse should assess this client soon, but it is not the highest priority.

B. A client who has missed a period and reports vaginal spotting could be experiencing an early pregnancy complication, such as a miscarriage or ectopic pregnancy. This situation requires attention, but it is not as urgent as painless vaginal bleeding in the third trimester.

C. A client at 14 weeks of gestation with nausea and vomiting is likely experiencing common pregnancy symptoms. While these symptoms can be uncomfortable and require management, they are not typically urgent.

D. A client at 28 weeks of gestation with painless vaginal bleeding could be experiencing placenta previa or another serious condition that poses an immediate risk to both the mother and the fetus. This situation requires urgent assessment and intervention.

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Correct Answer is D

Explanation

Choice A: Smoking is not directly associated with the development of type 1 diabetes mellitus in the baby.

Choice B: While smoking during pregnancy can have various effects on the baby's health, hearing loss is not one of the common complications.

Choice C: Although smoking during pregnancy is associated with an increased risk of congenital heart defects, intrauterine growth restriction is a more likely complication based on the client's smoking history.

Choice D: Smoking during pregnancy is associated with various adverse outcomes for both the mother and the baby. It can cause intrauterine growth restriction (IUGR), where the baby does not grow at the expected rate and has a lower birth weight. Smoking reduces blood flow to the placenta, which can affect the baby's growth and development.

A. The largest fetal diameter has passed through the pelvic outlet. B. The lowermost portion of the presenting part is at the level of the ischial spines. C. The posterior fontanel is palpable. D. The fetal head is in the left occiput posterior position.

Correct Answer is B

Explanation

A) The largest fetal diameter has passed through the pelvic outlet: This is an incorrect

interpretation of station 0. Station 0 means that the presenting part is at the level of the ischial spines, not fully descended through the pelvic outlet.

B) The lowermost portion of the presenting part is at the level of the ischial spines: This is the correct interpretation of station 0. Station 0 is the landmark at which the presenting part is at the level of the ischial spines in the maternal pelvis.
C) The posterior fontanel is palpable: The position of the fontanelle is not related to the station of the presenting part.
D) The fetal head is in the left occiput posterior position: The position of the fetal head is not indicated by the station measurement.

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A nurse in an antepartum unit is triaging clients. Which of the following clients should the nurse see first?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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