A patient who is 34 weeks pregnant attends the antepartal clinic and is diagnosed with mild pregnancy-induced hypertension (PIH). The decision is made to treat the patient at home.
Which instruction would be most appropriate to give to the patient?

Try to limit your intake of spicy foods.

Limit your intake of liquids to about a quart a day.

Be sure to urinate at least every two hours.

Rest on your side as much as possible.

Answer and Explanation

The Correct Answer is D

The correct answer is choice D. Rest on your side as much as possible. This is because resting on the side can improve blood flow to the placenta and lower blood pressure. It can also reduce the risk of supine hypotensive syndrome, which occurs when the weight of the uterus compresses the inferior vena cava and reduces venous return.

Choice A is wrong because spicy foods have no effect on blood pressure or pregnancy outcomes. Choice B is wrong because limiting fluid intake can lead to dehydration and increase blood viscosity, which can worsen hypertension. Choice C is wrong because urinating frequently does not lower blood pressure or prevent complications of pregnancy-induced hypertension.

Pregnancy-induced hypertension (PIH) is a condition that causes high blood pressure during pregnancy. It can lead to serious problems for both the mother and the baby, such as pre-eclampsia, eclampsia, placental abruption, fetal growth restriction, and stillbirth.

Women with PIH should follow their doctor’s advice on medication, diet, exercise, and monitoring. They should also report any symptoms of pre-eclampsia, such as severe headache, blurred vision, abdominal pain, or swelling.

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Correct Answer is B

Explanation

Choice A reason: Checking for bladder distention is a secondary nursing assessment to ensure the fetal head can descend properly. However, it does not address the patient's report of leaking fluid. While important for comfort and progress, it lacks the diagnostic priority required to differentiate between urine and amniotic fluid during labor admission.

Choice B reason: This is the priority action to confirm Spontaneous Rupture of Membranes (SROM). Nitrazine paper detects the alkaline pH of amniotic fluid, which turns the paper blue. According to NIH clinical guidelines, distinguishing amniotic fluid from acidic urine is essential to manage infection risks and plan appropriate obstetric interventions for labor.

Choice C reason: Testing for glucose is a metabolic screening tool used to monitor for gestational diabetes or renal threshold changes. It provides no clinical value in determining the status of the amniotic membranes. Following Maslow’s Hierarchy, ensuring physiological safety via membrane assessment takes precedence over routine metabolic urine screenings.

Choice D reason: Obtaining a culture is a diagnostic step for identifying pathogens like Group B Streptococcus, but it is not an initial assessment. Cultures require significant time for results and do not confirm rupture. Rapid bedside tests are the standard initial action to determine if the "bag of water" is broken.

A. “To determine fetal lung maturity.”. B. “To assess the degree of fetal renal function.”. C. “To test the amniotic fluid glucose level.”. D. “To detect the presence of fetal congenital anomalies.”.

Correct Answer is A

Explanation

Choice A reason:
At 37 weeks, especially in gestational diabetes, fetal lungs may still be immature. Amniocentesis checks lung maturity to ensure the baby can breathe effectively if early delivery is needed due to fetal compromise.

Choice B reason:
Fetal renal function is not typically assessed through amniocentesis at term. Kidney function is monitored via ultrasound, not by analyzing amniotic fluid at 37 weeks.

Choice C reason:
Amniotic fluid glucose levels are not used to manage gestational diabetes. Maternal blood glucose is the standard for monitoring and treatment.

Choice D reason:
Congenital anomalies are usually detected earlier in pregnancy. By 37 weeks, the focus of amniocentesis is on delivery planning, not anomaly detection.

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A patient who is 34 weeks pregnant attends the antepartal clinic and is diagnosed with mild pregnancy-induced hypertension (PIH). The decision is made to treat the patient at home. Which instruction would be most appropriate to give to the patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient who is 38 weeks pregnant is admitted to the hospital in active labor. On admission, the patient says, “For the past ten hours, I have been leaking small amounts of urine.” Which action should the nurse take initially?

Correct Answer is B

Explanation

A nurse is caring for a client who has gestational diabetes and is scheduled for an amniocentesis at 37 weeks of gestation due to suspected fetal compromise. What is the nurse’s best response to the client’s question as to why the amniocentesis test is being done?

Correct Answer is A

Explanation

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A patient who is 34 weeks pregnant attends the antepartal clinic and is diagnosed with mild pregnancy-induced hypertension (PIH). The decision is made to treat the patient at home.
Which instruction would be most appropriate to give to the patient?