A nurse is caring for a client who tells the nurse that she thinks she might be pregnant because she is able to feel the baby move. Which of the following statements should the nurse make?
"This is a positive sign of pregnancy.
"This is a possible sign of pregnancy."
"This is a presumptive sign of pregnancy."
"This is a probable sign of pregnancy"
The Correct Answer is C
A. "This is a positive sign of pregnancy." A positive sign of pregnancy includes objective evidence such as fetal heartbeat, fetal movement felt by the examiner, or visualizing the fetus on an ultrasound.
B. "This is a possible sign of pregnancy." Possible signs refer to physical changes that could indicate pregnancy but are not definitive, such as breast changes or uterine enlargement.
C. "This is a presumptive sign of pregnancy." Feeling fetal movement (quickening) is considered a presumptive sign because it is subjective and reported by the client, which may indicate pregnancy but is not definitive.
D. "This is a probable sign of pregnancy." Probable signs are objective signs observed by the examiner, such as a positive pregnancy test or Chadwick’s sign, but still not conclusive for pregnancy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["0.5"]
Explanation
The ordered dose is 1 mg, and the concentration available is 1 mg per 0.5 mL. Therefore, the nurse will administer 0.5 mL per dose.
Correct Answer is A
Explanation
A. Location of the placenta: Heavy, painless vaginal bleeding without contractions is a classic sign of placenta previa, where the placenta is abnormally positioned near or over the cervix. An ultrasound is used to determine placental location.
B. Rh incompatibility: Rh incompatibility is not associated with heavy vaginal bleeding, and ultrasound is not used to diagnose it. A blood test is required to assess Rh status.
C. Fetal lung maturity: Fetal lung maturity may be assessed in certain situations, but this is not related to the client's bleeding. The immediate concern is placental location.
D. Frequency and duration of contractions: The client has no contractions, and contractions are not the cause of heavy bleeding in this case. The priority is identifying placental issues.
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