A nurse is caring for a client who is at 34 weeks of gestation. Which of the following statements by the client is the nurse’s priority to report to the provider?

"My heart feels like it skips a beat."

"I have nosebleeds once per week."

"The palms of my hands are red and blotchy."

"I’m experiencing persistent headaches."

Answer and Explanation

The Correct Answer is A

Choice A reason: Palpitations at 34 weeks may signal arrhythmia or preeclampsia-related cardiac strain. This urgent symptom in pregnancy requires immediate provider evaluation.

Choice B reason: Weekly nosebleeds are common in pregnancy from vascular changes, less critical. Without severity, they’re not the priority over cardiac concerns.

Choice C reason: Red, blotchy palms (palmar erythema) are normal in pregnancy from estrogen. It’s benign, not urgent compared to potential heart issues.

Choice D reason: Persistent headaches suggest preeclampsia, but palpitations pose a more immediate cardiac risk. At 34 weeks, this takes reporting precedence.

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Correct Answer is A

Explanation

Choice A reason: Monitoring post-meals prevents purging, a common anorexia behavior. One hour ensures food retention, supporting nutritional recovery and countering compensatory actions effectively.

Choice B reason: Weighing every 2 days tracks trends, but daily is standard in anorexia to monitor refeeding risks like edema or cardiac strain more closely.

Choice C reason: Vital signs twice weekly miss acute changes in anorexia, like bradycardia from malnutrition. Daily checks are needed for safety during early treatment.

Choice D reason: Two hours per meal allows purging opportunities in anorexia. Shorter, supervised times prevent this, ensuring intake for nutritional rehabilitation success.

A. Increased urinary output B. Decreased hemoglobin level C. Increased weight of 0.91 kg (2 lb) D. Decreased BUN level

Correct Answer is A

Explanation

Choice A reason: Furosemide, a diuretic, increases urine output, reducing fluid overload in heart failure. This relieves pulmonary edema, showing the drug’s effectiveness clearly.

Choice B reason: Decreased hemoglobin isn’t tied to furosemide’s action; it reflects anemia, not fluid status. It doesn’t indicate diuretic efficacy in heart failure management.

Choice C reason: Weight gain signals fluid retention, opposite furosemide’s goal. Effective diuresis reduces weight, so this suggests treatment failure, not success.

Choice D reason: Decreased BUN may occur, but it’s not a primary furosemide marker. Urine output directly measures diuretic effect, making this less indicative.

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A nurse is caring for a client who is at 34 weeks of gestation. Which of the following statements by the client is the nurse’s priority to report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

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