A nurse is reinforcing dietary teaching with a client whose pregnancy BMI was 30.5. The nurse should include that which of the following is an acceptable weight gain for this client?
8 lb
32 lb
16 lb
24 lb.
The Correct Answer is C
Choice A Reason:
8 lb is not an appropriate weight gain for this client because it falls below the recommended range.
Choice B Reason:
32 lb is excessive weight gain for a client with a prepregnancy BMI of 30.5. Excessive weight gain during pregnancy can increase the risk of various complications, including gestational diabetes, hypertension, and larger-than-average birth weight.
Choice C Reason:
16 lb is within the recommended range for weight gain during pregnancy for a client with a prepregnancy BMI of 30.5. This falls in the range of approximately 11 to 20 pounds (5 to 9 kilograms) of weight gain.
Choice D Reason:
24 lb is above the upper limit of the recommended weight gain range for a client with a prepregnancy BMI of 30.5. It exceeds the upper limit of approximately 20 pounds (9 kilograms) of weight gain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason:
The cause of death is determined and documented by the physician or medical examiner, not the nurse. Including this in the postmortem documentation by the nurse would be inappropriate as it is not within the nurse's scope of practice to make this determination.
Choice B Reason:
While the nurse may document the last set of vital signs before death, this is typically recorded in the patient's medical record at the time the vital signs are taken, not specifically in postmortem documentation. The focus of postmortem documentation is on the events and conditions after the death has been confirmed.
Choice C Reason:
The location of the identification tag is crucial in postmortem documentation to ensure proper identification of the deceased. This information helps in maintaining the integrity and identification of the body during transportation and handling by the mortuary or funeral home.
Choice D Reason:
Advance directives are part of the client's medical record and are used to guide care decisions while the client is alive. They are not typically included in postmortem documentation, as they pertain to the client's wishes regarding treatment prior to death, not after. The original documents should remain in the client's file.
Correct Answer is ["B","D","E","F"]
Explanation
b, d, e, and f.
b. Initiate a power of atorney for health care document: One of the primary responsibilities of a nurse in relation to advance directives is to initiate the process of creating an advance directive. This includes assisting the client in completing a power of atorney for health care document, which designates a person to make healthcare decisions for the client if they are unable to do so.
d. Provide the client with writen information about advance directives: It is important for the nurse to provide the client with writen information about advance directives, including their rights and options for creating an advance directive. This information should be provided in a clear and understandable manner.
c. Communicate advance directives status via the medical record and shift report: The nurse should communicate the client's advance directives status to other members of the healthcare team via the medical record and shift report. This ensures that everyone involved in the client's care is aware of the client's wishes and can provide care that is consistent with those wishes.
f. Instruct the client that an advance directive is a legal document and must be honored by care providers: The nurse should instruct the client that an advance directive is a legal document that must be honored by care providers. This ensures that the client understands the importance of their advance directive and can advocate for their wishes if necessary.
a. Inform the client that an advance directive discontinues further care: This option is incorrect. An advance directive does not automatically discontinue further care. It simply provides guidance to healthcare providers on the client's wishes for medical treatment. It is important for the nurse to explain this to the client and ensure that they understand the purpose of an advance directive.
c. Document that the provider discussed do-not-resuscitate status with the client: This option is also incorrect. While discussing do-not-resuscitate status may be part of the advance directive process, it is not one of the primary responsibilities of the nurse in relation to advance directives. The nurse should ensure that the client's wishes regarding resuscitation are documented in their advance directive, but they do not need to document that the provider discussed this topic with the client.
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