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A nurse is reinforcing teaching with a client at her first prenatal visit about expected changes during gestation. (Arrange the steps in order, placing them in the selected order of occurrence from earliest to latest in gestation. Use all the steps.)

Breast tenderness

Nausea and vomiting

Quickening

Goodell's sign

Striae gravidarum

Lightening

Answer and Explanation

Correct Answer : A,B,C,D,E,F

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Correct Answer is B

Explanation

The nurse should tell the client that the recommendation for her is about 15 to 25 pounds, as this is the range of weight gain that is considered healthy and appropriate for a pregnant woman who has a BMI of 26.5, which falls in the overweight category (BMI of 25 to 29.9). The weight gain should be gradual and consistent, with an average of

0.6 pounds per week in the second and third trimesters.

a. The nurse should not tell the client that a gain of about 25 to 35 pounds is best for her and for her baby, as this is the range of weight gain that is recommended for a pregnant woman who has a normal BMI (18.5 to 24.9). Gaining more weight than necessary can increase the risk of gestational diabetes, hypertension, preeclampsia, cesarean delivery, and postpartum weight retention.

c. The nurse should not tell the client that she should gain 11 to 20 pounds, as this is the range of weight gain that is advised for a pregnant woman who has a BMI of 30 or higher, which falls in the obese category. Gaining less weight than needed can compromise fetal growth and development, and increase the risk of preterm birth, low birth weight, and intrauterine growth restriction.

d. The nurse should not tell the client that it really doesn't mater exactly how much weight she gains, as long as her diet is healthy, as this is a vague and inaccurate statement that does not provide any guidance or education to the client. The amount of weight gain during pregnancy does mater, as it aﬀects both maternal and fetal health and outcomes. A healthy diet is important, but it is not the only factor that inﬂuences weight gain. The nurse should also consider the client's pre-pregnancy weight, physical activity level, medical history, and gestational age.

A. "What else have you been eating?" B. "Go to the emergency room and your provider will meet you there." C. "This is expected because of the way iron is broken down during digestion." D. "Come to the office and we will check things out."

Correct Answer is C

Explanation

c. "This is expected because of the way iron is broken down during digestion."

The client's stools are black because of the iron supplements, which can cause a harmless change in the color and consistency of the stools. This is due to the oxidation of iron in the gastrointestinal tract, which produces a black pigment called ferrous sulfide. This is not a sign of bleeding or infection and does not require further evaluation or treatment. The nurse should reassure the client that this is a normal side eﬀect of iron supplements and advise her to continue taking them as prescribed.

The other responses are not appropriate and may cause unnecessary anxiety or inconvenience for the client.

The nurse should not ask the client what else she has been eating, as this implies that her diet may be causing her stools to be black. This may confuse or oﬀend the client, who may think that the nurse is questioning her nutritional choices or blaming her for her condition.

The nurse should not tell the client to go to the emergency room, as this suggests that her stools are black because of a serious problem that needs immediate atention. This may frighten or alarm the client, who may think that she or her baby are in danger.

d. The nurse should not tell the client to come to the office, as this indicates that her stools are black because of an abnormal finding that needs further investigation. This may worry or inconvenience the client, who may think that she has a complication or infection that requires testing or treatment.

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A nurse is reinforcing teaching with a client at her first prenatal visit about expected changes during gestation. (Arrange the steps in order, placing them in the selected order of occurrence from earliest to latest in gestation. Use all the steps.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who is pregnant and has a body mass index (BMI) of 26.5. She asks the nurse how much weight she should gain over the course of her pregnancy. Which of the following statements is an appropriate response by the nurse?

Correct Answer is B

Explanation

A nurse is speaking on the phone to a client who is pregnant and taking iron supplements for iron-deficiency anemia. The client reports that her stools are black but she has no abdominal pain or cramping. Which of the following responses by the nurse is appropriate?

Correct Answer is C

Explanation

A nurse is reinforcing teaching with a client who is at 34 weeks of gestation and at risk for placental abruption. The nurse recognizes that which of the following is the most common risk factor for a placental abruption?

A nurse is caring for a client who is at 34 weeks of gestation and has a suspected placenta previa. Which of the following actions should the nurse take?

A nurse in the prenatal clinic is reinforcing teaching to a client who is in her second trimester and has a new diagnosis of gestational diabetes. Which statement by the client indicates a need for further teaching?

A nurse is caring for a client who might have a hydatidiform mole. The nurse should monitor the client for which of the following findings?

A nurse is reinforcing teaching to a client regarding how to reduce the risk of giving birth to a newborn who has a neural tube defect. Which of the following instructions by the nurse is appropriate?

A nurse in the prenatal clinic is reinforcing teaching to a client who is in her second trimester and has a new diagnosis of gestational diabetes. Which statement by the client indicates a need for further teaching?