A nurse is providing teaching to a client who is pregnant and has phenylketonuria (PKU). Which of the following foods should the nurse instruct the client to eliminate from her diet?

Choice A rationale

While it’s important for the nurse to provide reassurance and support during the exam, this statement alone doesn’t address the client’s specific concerns or provide any useful information.

Choice B rationale

Telling the client to relax doesn’t address her concerns or provide any useful information. It’s normal to feel nervous before a pelvic exam, especially if it’s the first one.

Choice C rationale

Asking the client what part of the exam makes her most nervous allows the nurse to provide specific information and reassurance, which can help alleviate the client’s anxiety.

Choice D rationale

While a pelvic exam is often part of the process when starting oral contraceptives, it’s not always required. The need for a pelvic exam can depend on the client’s age, sexual history, and other factors.

The correct answer is Choice C.

Choice A rationale: Inserting an IV catheter is important for potential fluid and medication administration, but it is not the immediate priority action.

Choice B rationale: Administering glucocorticoids is important for fetal lung maturity in case of preterm birth, but it is not the immediate priority upon admission.

Choice C rationale: Applying an external fetal monitor is the priority action. It allows for continuous monitoring of the fetal heart rate and uterine activity to assess the well-being of the fetus and detect any signs of distress.

Choice D rationale: Monitoring vaginal bleeding is important for managing placenta previa, but it is not the immediate priority. Continuous fetal monitoring takes precedence to ensure fetal safety.