A nurse is assessing a client who may be pregnant. The nurse reviews the client's history for presumptive signs. Which signs would the nurse most likely note? Select all that apply.

Nausea

Abdominal enlargement

Positive pregnancy test

Braxton Hicks contractions

Amenorrhea

Answer and Explanation

Correct Answer : A,B,C,E

Choice A Reason: Nausea is a common presumptive sign of pregnancy, especially in the first trimester. It is caused by hormonal changes and may be accompanied by vomiting.

Choice B Reason: Abdominal enlargement is another presumptive sign of pregnancy, as the uterus grows to accommodate the developing fetus. It may be noticeable as early as 12 weeks of gestation.

Choice C Reason: A positive pregnancy test is a presumptive sign of pregnancy, as it detects the presence of human chorionic gonadotropin (hCG), a hormone produced by the placenta. However, it is not a definitive sign, as it may be affected by other factors such as medications, tumors, or false positives.

Choice D Reason: Braxton Hicks contractions are not a presumptive sign of pregnancy, but a probable sign. They are irregular and painless contractions of the uterus that occur throughout pregnancy, but become more frequent and noticeable in the third trimester. They are also known as false labor contractions.

Choice E Reason: Amenorrhea, or the absence of menstrual periods, is a presumptive sign of pregnancy, as it indicates that ovulation has ceased. However, it is not a definitive sign, as it may be caused by other factors such as stress, illness, or hormonal imbalances.

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Correct Answer is A

Explanation

Choice A Reason: This is correct because this description accurately reflects one of the main functions of amniotic fluid, which is to act as a shock absorber and buffer against external forces or movements that could harm the fetus. Amniotic fluid also allows the fetus to move freely and develop its muscles and bones.

Choice B Reason: This is incorrect because this description is false. The amount of amniotic fluid changes throughout the pregnancy, depending on the stage of fetal development and other factors. The normal range of amniotic fluid volume is between 500 and 1000 mL at term. Too much or too little amniotic fluid can indicate a problem with the fetus or the placenta.

Choice C Reason: This is incorrect because this description is false. The fluid is not mostly protein, but mostly water (about 98%). The water comes from the mother's blood plasma and the fetal urine. The remaining 2% of amniotic fluid consists of various substances, such as electrolytes, hormones, enzymes, antibodies, and fetal cells. Amniotic fluid does not provide nourishment to the fetus, but rather protects it from infection and helps regulate its temperature.

Choice D Reason: This is incorrect because this description is false. Amniotic fluid does not act as a transport mechanism for oxygen and nutrients, but rather as a barrier that prevents them from reaching the fetus directly. Oxygen and nutrients are delivered to the fetus through the placenta and the umbilical cord, which are connected to the maternal blood circulation.

A. Cervical insufficiency B. Uterine fibroids C. Fetal genetic abnormalities D. Maternal disease

Correct Answer is C

Explanation

Choice A Reason: This is incorrect because cervical insufficiency is a condition where the cervix dilates prematurely and painlessly during pregnancy, leading to preterm delivery or second trimester abortion. It is not a common cause of first trimester abortion, which occurs before 12 weeks of gestation.

Choice B Reason: This is incorrect because uterine fibroids are benign tumors that grow in or on the uterus. They may cause heavy bleeding, pain, or infertility, but they are not a common cause of first trimester abortion. They may increase the risk of miscarriage in later stages of pregnancy.

Choice C Reason: This is correct because fetal genetic abnormalities are the most common cause of first trimester abortion, accounting for up to 70% of cases. Fetal genetic abnormalities are errors in the number or structure of chromosomes that occur during fertilization or cell division. They can cause developmental defects or fetal demise that result in spontaneous abortion.

Choice D Reason: This is incorrect because maternal disease is not a common cause of first trimester abortion. Maternal disease refers to any medical condition that affects the mother's health or pregnancy outcome, such as diabetes, hypertension, thyroid disorders, or infections. Maternal disease may increase the risk of miscarriage in later stages of pregnancy or cause other complications such as preterm labor or preeclampsia.

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A nurse is assessing a client who may be pregnant. The nurse reviews the client's history for presumptive signs. Which signs would the nurse most likely note? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During a prenatal visit, a pregnant woman says, "I know the amniotic fluid is important, but can you tell me more about it?" When describing amniotic fluid to a pregnant woman, which description would the nurse most likely include?

Correct Answer is A

Explanation

A nurse is conducting an in-service program for a group of nurses working at the women's health facility about the causes of spontaneous abortion. The nurse determines that the teaching was successful when the group identifies which condition as the most common cause of first trimester abortions?

Correct Answer is C

Explanation

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