A nurse is caring for a client who is at 26 weeks of gestation. Which of the following statements indicates the client is having difficulty accepting the body image changes associated with pregnancy?

"I've been wearing the same few things every day because most of my clothes don't fit anymore."

"Dressing up for work is a little harder now that I can't wear high heels."

"I've had to start wearing nursing bras already because my breasts are growing so much."

"When I wear high-top yoga pants, they hold my belly in so you can't even tell I'm pregnant."

Answer and Explanation

The Correct Answer is D

A. "I've been wearing the same few things every day because most of my clothes don't fit anymore." This statement reflects a common experience during pregnancy as the body changes. While it may indicate some frustration, it does not necessarily suggest difficulty accepting body image changes.
B. "Dressing up for work is a little harder now that I can't wear high heels." This statement acknowledges an adjustment in clothing choices due to pregnancy but does not indicate distress about body image. Many individuals modify their footwear for comfort and safety as pregnancy progresses.
C. "I've had to start wearing nursing bras already because my breasts are growing so much." This statement reflects awareness of bodily changes rather than difficulty accepting them. Breast enlargement is a normal part of pregnancy, and choosing appropriate clothing to accommodate these changes suggests adaptation rather than distress.
D. "When I wear high-top yoga pants, they hold my belly in so you can't even tell I'm pregnant." This statement suggests an attempt to conceal the pregnancy, which may indicate discomfort with body image changes. Actively trying to hide the pregnancy rather than embracing the natural progression of body changes can be a sign of difficulty accepting the physical transformation.

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Correct Answer is B

Explanation

A. Completely undress the toddler. Toddlers may feel vulnerable when fully undressed. It is best to remove clothing gradually, assessing one area at a time, to promote comfort and reduce anxiety.
B. Allow the toddler to handle the equipment. Letting the toddler touch and explore medical equipment, such as a stethoscope or otoscope, helps reduce fear and increases cooperation during the examination. This approach fosters a sense of control and familiarity.
C. Thoroughly explain each procedure to the toddler. Toddlers have limited understanding and attention spans. Simple, short explanations and distraction techniques are more effective in easing anxiety than detailed explanations.
D. Start the examination with routine immunizations. Painful procedures, such as vaccinations, should be saved for the end of the visit to prevent distress and resistance that could interfere with the rest of the examination.

A. Remove the tape by pulling from the center of the dressing. B. Clean the wound from the center to the outer edges. C. Moisten the dressing before removal. D. Wear sterile gloves to remove the dressing

Correct Answer is B

Explanation

A. Remove the tape by pulling from the center of the dressing. Tape should be removed by pulling toward the wound rather than from the center to avoid skin trauma and unnecessary disruption to the healing tissue. Pulling from the center can increase discomfort and damage surrounding skin.
B. Clean the wound from the center to the outer edges. Cleaning from the center outward prevents the introduction of microorganisms from the surrounding skin into the wound, reducing the risk of further infection. This technique follows the principle of working from the cleanest area to the least clean.
C. Moisten the dressing before removal. A wet-to-dry dressing is meant to adhere to necrotic tissue and debris, which is then removed when the dry dressing is taken off. Moistening it before removal defeats this purpose by softening the dressing, reducing its effectiveness in debriding the wound.
D. Wear sterile gloves to remove the dressing. Clean gloves are appropriate for removing a contaminated dressing. Sterile gloves are necessary for applying the new dressing to maintain an aseptic environment. Using sterile gloves for removal is unnecessary and does not improve infection control.

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A nurse is caring for a client who is at 26 weeks of gestation. Which of the following statements indicates the client is having difficulty accepting the body image changes associated with pregnancy?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a toddler during a well-child visit. Which of the following actions should the nurse take to prepare the toddler for a physical examination?

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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