A nurse is caring for a client who has a positive pregnancy test. The nurse is teaching the client about common discomforts in the first trimester of pregnancy as well as warning signs of potential danger. The nurse should instruct the client to call the clinic if she experiences which of the following manifestations?

"Leukorrhea."

"Painful and tender area on leg."

"Nausea and vomiting."

"Urinary frequency."

Answer and Explanation

The Correct Answer is B

Choice A: Leukorrhea, which refers to an increase in vaginal discharge, is a common discomfort during pregnancy and is generally not a cause for concern.

Choice B: Painful and tender areas on the leg may be a sign of deep vein thrombosis (DVT), a potentially dangerous condition. During pregnancy, there is an increased risk of developing blood clots, and DVT can be a serious complication that requires immediate medical attention.

Choice C: Nausea and vomiting are common in early pregnancy and are usually associated with morning sickness. While it can be uncomfortable, it is generally not considered a dangerous symptom unless it leads to severe dehydration.

Choice D: Urinary frequency is a common discomfort during pregnancy, especially in the first and third trimesters. Although it can be bothersome, it is not typically a sign of immediate danger.

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Correct Answer is B

Explanation

Choice A: Assessing the client's temperature is important, but it is not the priority immediately after an amniotomy. Fetal wellbeing takes precedence.

Choice B; After an amniotomy (artificial rupture of membranes), the priority nursing action is to assess the fetal heart rate and pattern. The procedure may cause changes in fetal heart rate and indicate fetal distress or cord compression, requiring immediate attention.

Choice C: Recording the color and consistency of fluid is relevant for documentation but does not address the immediate concern of fetal wellbeing.

Choice D: Evaluating the client for chills and uterine tenderness is not the priority after an amniotomy. Monitoring the fetal heart rate is crucial to detect any signs of distress.

A. "Don't worry. You will be fine once the baby is born." B. "Ambivalent feelings are quite common for women early in pregnancy." C. "Perhaps you should see a counselor to discuss these feelings further." D. "Have you spoken to your mother about these feelings?"

Correct Answer is B

Explanation

Choice A: This response is dismissive and does not validate the client's feelings. It may not address the client's concerns effectively.

Choice B: This response validates the client's feelings and reassures her that ambivalent feelings about pregnancy are common. It provides a supportive approach and normalizes her emotions.

Choice C: While counseling might be helpful for some clients, suggesting it immediately without further assessment of the client's needs may not be the most appropriate response at this stage.

Choice D: Encouraging the client to discuss her feelings with her mother may not be suitable, as the client might prefer professional support or may not have a positive relationship with her

mother. It is essential to avoid making assumptions about the client's support system and address her concerns empathetically.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is to undergo an amniotomy. Which of the following is the priority nursing action immediately following this procedure?

Correct Answer is B

Explanation

Correct Answer is B

Explanation

A nurse is assessing a client who is in the third trimester of pregnancy. The nurse should recognize which of the following findings as an expected physiologic change during pregnancy?

A nurse is caring for a client who is in active labor and notes late decelerations on the fetal monitor. Which of the following is the priority nursing action?

A nurse is observing the electronic fetal heart rate monitor tracing for a client who is at 40 weeks of gestation and is in labor. The nurse should suspect a problem with the umbilical cord when he observes which of the following patterns?

A nurse is instructing a woman who is contemplating pregnancy about nutritional needs. To reduce the risk of giving birth to a newborn who has a neural tube defect, which of the following information should the nurse include in the teaching?

A nurse is caring for a client who is 42 weeks of gestation. Based on the assessment findings, which of the following actions should the nurse plan to take? (Select all that apply.)

A nurse is caring for a client who experienced a cesarean birth due to dysfunctional labor. The client states that she is disappointed that she did not have natural childbirth. Which of the following responses should the nurse make?

A nurse is admitting a client who is at 38 weeks of gestation and is in the active phase of the first stage of labor. Which of the following assessment findings is the first priority for the nurse to report to the provider?