A nurse is assisting in the care of a client at 30 weeks of gestation who has a blood pressure reading of 160/116 mm Hg and 4 hours previously it was 164/114 mm Hg. The client reports blurred vision and a persistent frontal headache.
Which of the following complications of gestation should the nurse suspect?

Gestational hypertension.

Preeclampsia with severe features.

Preeclampsia without severe features.

Chronic hypertension.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Gestational hypertension is diagnosed when high blood pressure develops after 20 weeks of pregnancy without other symptoms of preeclampsia, such as proteinuria or end-organ dysfunction.

Choice B rationale

Preeclampsia with severe features includes high blood pressure, proteinuria, and symptoms like blurred vision and headaches. These indicate severe disease, which can endanger both the mother and the fetus if left untreated.

Choice C rationale

Preeclampsia without severe features involves high blood pressure and proteinuria but without the additional severe symptoms like blurred vision and headache.

Choice D rationale

Chronic hypertension refers to high blood pressure that was present before pregnancy or diagnosed before 20 weeks of gestation. It does not typically present with acute symptoms like blurred vision and headache that develop suddenly.

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Correct Answer is A

Explanation

Choice A rationale

Abruptio placentae involves the premature separation of the placenta from the uterine wall, causing continuous abdominal pain and vaginal bleeding. This condition is a medical emergency that can compromise fetal and maternal health.

Choice B rationale

Premature rupture of membranes is characterized by the leaking or gushing of amniotic fluid, not continuous abdominal pain and vaginal bleeding. It usually doesn't present with severe pain unless there are complications like infection.

Choice C rationale

Placenta previa is where the placenta covers the cervical opening, causing painless vaginal bleeding. It typically does not involve continuous abdominal pain, distinguishing it from abruptio placentae.

Choice D rationale

Prolapsed cord occurs when the umbilical cord slips ahead of the baby during delivery, which is a different obstetric emergency. It does not present with continuous abdominal pain and vaginal bleeding.

A. Respect the client's right to decline genetic testing. B. Call the client and attempt to schedule another appointment. C. Offer the client an appointment with a different genetic counselor. D. Plan to perform genetic testing at the client's next prenatal visit.

Correct Answer is A

Explanation

Choice A rationale

Respecting the client's decision to decline genetic testing upholds their autonomy and right to make informed decisions about their own healthcare.

Choice B rationale

Persistently attempting to schedule another appointment could be seen as pressuring the client, which may not be respectful of their initial decision.

Choice C rationale

Offering an appointment with a different genetic counselor may imply that the client's decision was not respected or understood, which can be perceived as dismissive.

Choice D rationale

Planning to perform genetic testing without the client's consent disregards their autonomy and the importance of informed consent in healthcare decisions.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in the antepartum unit is assisting with the care of a client who is at 36 weeks of gestation and reports continuous abdominal pain and vaginal bleeding. The nurse should identify that the client is likely experiencing which of the following complications?

Correct Answer is A

Explanation

A nurse is following up with a client at 12 weeks gestation who was seen for genetic counseling but decided not to proceed with genetic testing or any further genetic counseling. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

A nurse is caring for a client who is postpartum. Which of the following findings is an indication for the nurse to administer Rho(D) immune globulin?

A nurse is assisting in the care of a client who has preeclampsia with severe features and is reporting blurred vision and the inability to think clearly. Which of the following factors should the nurse recognize as the primary cause of the client's clinical manifestations?

A nurse is contributing to the care of a newborn who is experiencing hyperbilirubinemia and is receiving phototherapy. Which of the following findings indicate that the phototherapy is effective?

A nurse is collecting data from the electronic health records (EHR) of a group of clients before their prenatal visits. Which of the following clients should the nurse identify as at risk for hypothyroidism?

A nurse is assisting with the care of a client who is in labor. The client's labor is difficult and prolonged and she reports a severe backache. Which of the following factors is a contributing cause of difficult, prolonged labor?

A nurse is assisting in the discharge planning of a postpartum client. Which of the following teaching points about car seat safety should the nurse reinforce in the teaching?

A nurse is reinforcing teaching about hyperthyroidism with a client at 10 weeks of gestation who has the condition. Which of the following statements should the nurse reinforce in the teaching?

A nurse is preparing to administer vitamin K 1mg IM to a newborn. Available is vitamin K injection 1 mg/0.5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)