A nurse is caring for a client who is at 41 weeks of gestation.
The nurse should understand that which of the following findings can indicate a prenatal complication in this client?
Leukorrhea.
Shortness of breath.
Non-pitting ankle edema.
Blurred vision.
The Correct Answer is D
Choice A rationale
Leukorrhea, a normal vaginal discharge, increases during pregnancy due to hormonal changes. It's not indicative of prenatal complications at 41 weeks of gestation.
Choice B rationale
Shortness of breath is common in late pregnancy due to the enlarged uterus pressing against the diaphragm. It is not necessarily a sign of a prenatal complication at this stage.
Choice C rationale
Non-pitting ankle edema is often seen in late pregnancy due to fluid retention and increased pressure on the veins. It is typically benign and not a sign of serious complications.
Choice D rationale
Blurred vision can indicate a serious prenatal complication such as preeclampsia, which is characterized by high blood pressure and can pose significant risks to both mother and baby if not managed properly. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Mongolian spots are common, benign skin markings that some newborns have, but they are not related to rubella exposure during pregnancy.
Choice B rationale
Jaundice is a common condition in newborns, characterized by a yellowing of the skin and eyes, usually due to an immature liver. It's not specifically linked to maternal rubella exposure.
Choice C rationale
Transient strabismus, or temporary misalignment of the eyes, can occur in newborns but is unrelated to rubella. It usually resolves on its own as the newborn's muscles develop.
Choice D rationale
Deafness is a significant risk associated with congenital rubella syndrome. Rubella can damage the developing auditory system in utero, leading to permanent hearing loss in the newborn.
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"B"}
Explanation
The nurse should plan to:
A. Check the client's blood glucose level; then B. Implement seizure precautions
In the context of a postpartum client with type 1 diabetes, symptoms such as diaphoresis, clammy skin, rapid pulse, and feeling weak can suggest hypoglycemia, which needs to be immediately addressed. Checking the client's blood glucose level will confirm if hypoglycemia is present.
Implementing seizure precautions is necessary because severe hypoglycemia can lead to seizures, especially if it remains untreated.
- Checking the client's blood glucose level helps identify if the client is experiencing hypoglycemia, a common complication in diabetic patients.
- Implementing seizure precautions ensures the client's safety in case of severe hypoglycemia, which can result in neurological symptoms or seizures.
Other options such as drawing blood for culture and sensitivity are less relevant here because there are no signs of infection. Having the client drink soda is a potential action but less immediately critical compared to confirming hypoglycemia first. Administering an IV bolus of dextrose is another direct treatment for hypoglycemia, yet confirming hypoglycemia before any treatment is vital.
Checking deep tendon reflexes, obtaining a urine sample to test for ketones, and applying a warm compress to the abdomen are not immediate priorities in the context of the described symptoms.
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