A nurse is caring for a client who is at 36 weeks of gestation and reports a headache.

Which of the following actions should the nurse take? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Graphic Results Temperature 37° C (98.6° F) Heart rate 88/min Respiratory rate 18/min

Blood pressure 144/94 mm Hg

Upper abdominal pain rating 4/10 on a scale from 0 to 10

Perform a contraction stress test.

Prepare for delivery of the fetus.

Increase the client's dietary salt intake to 2 g/day.

Administer ferrous sulfate to the client.

Upper abdominal pain rating 4/10 on a scale from 0 to 10

Answer and Explanation

The Correct Answer is B

Choice A rationale:

A contraction stress test is not appropriate in this context and would not address the potential risks associated with the client's symptoms.

Choice B rationale:

The elevated blood pressure and upper abdominal pain suggest potential preeclampsia, a serious complication of pregnancy that can lead to significant maternal and fetal risks. Delivery may be indicated to prevent further complications.

Choice C rationale:

Increasing dietary salt intake is not recommended for managing elevated blood pressure in pregnancy.

Choice D rationale:

Administering ferrous sulfate is unrelated to the client's symptoms and concerns.

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Correct Answer is B

Explanation

Choice A rationale:

A fasting blood glucose level of 96 mg/dL is within a normal range and is not typically associated with carbidopa/levodopa therapy.

Choice B rationale:

Hemoglobin levels of 10 g/dL may indicate anemia, which can exacerbate symptoms in clients with Parkinson's disease and affect the effectiveness of carbidopa/levodopa.

Choice C rationale:

A platelet count of 200,000/mm3 is within a normal range and is not typically associated with carbidopa/levodopa therapy.

Choice D rationale:

A blood urea nitrogen (BUN) level of 10 mg/dL is within a normal range and is not typically associated with carbidopa/levodopa therapy.

A. Check cervical dilation every 2 hr. B. Initiate an IV with an 18-gauge catheter. C. Monitor FHR hourly. D. Obtain vital signs every 4 hr.

Correct Answer is B

Explanation

Choice A rationale:

Frequent cervical examinations may increase the risk of introducing infection or causing additional bleeding. Cervical examinations are not a priority in managing placental abruption.

Choice B rationale:

Placental abruption can lead to significant blood loss, and the client may require intravenous fluids and blood products to maintain hemodynamic stability. Initiating an IV with an 18-gauge catheter allows for rapid administration of fluids and blood products if needed.

Choice C rationale:

Monitoring fetal heart rate hourly is important, but addressing the mother's hemodynamic stability with IV fluids takes priority.

Choice D rationale:

Vital signs should be obtained more frequently than every 4 hours due to the risk of ongoing blood loss.

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Naxlex Comprehensive Predictor Exams

A nurse is reviewing the laboratory results of a client who has Parkinson's disease and a prescription for carbidopa/levodopa. Which of the following values should the nurse report to the provider?

Correct Answer is B

Explanation

A nurse is planning care for a client who is experiencing moderate vaginal bleeding due to a placental abruption. Which of the following interventions should the nurse include in the plan?

Correct Answer is B

Explanation

A nurse is performing an admission assessment for an older adult client. The nurse should identify that which of the following findings is a manifestation of possible elder maltreatment?

A nurse is preparing to administer the influenza vaccine to a group of clients. For which of the following clients should the nurse withhold the vaccine?

A nurse is caring for a client who has a new diagnosis of Alzheimer's disease. Which of the following medications should the nurse expect the provider to prescribe?

A nurse is providing teaching to a young adult client who has fibrocystic breast condition. Which of the following instructions should the nurse include in the teaching?

A nurse is providing teaching about physiological changes that occur during the dying process to the family of a client who has a terminal illness. Which of the following manifestations should the nurse include?

A nurse is creating a plan of care for a client who has antisocial personality disorder. Which of the following interventions should the nurse include?

A nurse is developing a plan of care for a client who has schizophrenia and is experiencing auditory hallucinations. Which of the following actions should the nurse plan to take? (Select all that apply.)

A nurse is planning care for a client who has leukemia and is prescribed bed rest. Which of the following interventions should the nurse include in the plan?