A nurse is admitting a client who is 33 weeks pregnant and diagnosed with placenta previa.
What is the priority nursing action?
Insert an IV catheter.
Administer glucocorticoids.
Apply an external fetal monitor.
Monitor vaginal bleeding.
None
None
The Correct Answer is C
The correct answer is Choice C.
Choice A rationale: Inserting an IV catheter is important for potential fluid and medication administration, but it is not the immediate priority action.
Choice B rationale: Administering glucocorticoids is important for fetal lung maturity in case of preterm birth, but it is not the immediate priority upon admission.
Choice C rationale: Applying an external fetal monitor is the priority action. It allows for continuous monitoring of the fetal heart rate and uterine activity to assess the well-being of the fetus and detect any signs of distress.
Choice D rationale: Monitoring vaginal bleeding is important for managing placenta previa, but it is not the immediate priority. Continuous fetal monitoring takes precedence to ensure fetal safety.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
GTPAL calculation:
Step 1 is: Determine Gravida (G) = 4 pregnancies (1 elective abortion, 1 twin birth, 1 spontaneous abortion, 1 current pregnancy) = G4.
Step 2 is: Determine Term (T) births = 0 (no pregnancies reached 37 weeks).
Step 3 is: Determine Preterm (P) births = 1 (twin birth at 36 weeks) = P1.
Step 4 is: Determine Abortion (A) = 2 (1 elective abortion at 9 weeks, 1 spontaneous abortion at 15 weeks) = A2.
Step 5 is: Determine Living (L) children = 2 (twins) = L2.
The GTPAL status is: G4 T0 P1 A2 L2.
Correct Answer is A
Explanation
Choice A rationale
Moderate exercise improves circulation. This statement is accurate and should be included in the teaching. Regular moderate exercise during pregnancy can have many benefits, including improved circulation, which can help reduce swelling and varicose veins. It can also help manage weight gain, improve mood and energy levels, reduce pregnancy discomfort, prepare the body for labor, and boost stamina for labor and delivery.
Choice B rationale
Refrain from exercises that include stretching. This statement is not accurate and should not be included in the teaching. Stretching exercises can be beneficial during pregnancy. They can help improve flexibility, reduce muscle tension, alleviate pregnancy discomfort, and prevent muscle imbalances. However, pregnant women should be careful not to stretch too far, as the hormones produced during pregnancy can make the ligaments more flexible and easier to stretch, increasing the risk of injuries.
Choice C rationale
It is recommended to rest for 30 minutes before each new exercise. This statement is not accurate and should not be included in the teaching. While it’s important for pregnant women to rest and avoid overexertion, there’s no specific recommendation to rest for 30 minutes before each new exercise. Instead, pregnant women should listen to their bodies and rest as needed.
Choice D rationale
It is recommended to increase your weight-bearing exercises. This statement is not accurate and should not be included in the teaching. While weight-bearing exercises can be beneficial, they should be done with caution during pregnancy. Pregnant women should avoid heavy weights and exercises that put pressure on the joints, increase the risk of injury, or cause discomfort. Instead, they should focus on exercises that strengthen the muscles and improve balance and flexibility.
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