As a nurse in an antepartum unit performing triage, which client should be prioritized?
A client who has missed a menstrual cycle and reports vaginal spotting.
A client who is at 28 weeks of gestation and reports painless vaginal bleeding.
A client who is at 38 weeks of gestation and reports symptoms of a cough and fever.
A client who is at 14 weeks of gestation and reports experiencing nausea and vomiting.
The Correct Answer is B
Choice A rationale
Missing a menstrual cycle and reporting vaginal spotting could indicate early pregnancy or other non-emergency conditions. While this client should be evaluated, it is not the highest priority.
Choice B rationale
A client at 28 weeks of gestation reporting painless vaginal bleeding could be experiencing placenta previa or placental abruption, both of which are obstetric emergencies. This client should be prioritized for immediate evaluation.
Choice C rationale
A client at 38 weeks of gestation reporting symptoms of a cough and fever may have an upper respiratory infection. While this should be evaluated, it is not the highest priority unless the client is in distress.
Choice D rationale
Nausea and vomiting are common in early pregnancy. A client at 14 weeks of gestation reporting these symptoms would need evaluation, but it is not the highest priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The GTPAL system is used to evaluate a woman’s complete obstetric history. In this system: G stands for Gravida, which refers to the number of times a woman has been pregnant, including any current pregnancy. T stands for Term births, referring to the number of times an
individual has carried a pregnancy to at least 37 weeks of gestation and delivered. P stands for Preterm deliveries, which includes babies born between 20 and 36 weeks 6/7 days of gestation. A stands for the number of abortions, referring to all times the individual has lost a pregnancy before 20 weeks. L stands for the number of Living children. In this case, the woman is pregnant for the fourth time (G4). She has had one full-term pregnancy (T1), two preterm pregnancies (P2), no abortions (A0), and all her children from previous pregnancies are living (L3). Therefore, her gravidity and parity using the GTPAL system is G4 T1 P2 A0 L3.
Correct Answer is ["0.3"]
Explanation
Step 1 is to identify the concentration of the medication. From the search results, enoxaparin comes in pre-filled syringes with different concentrations, one of which is 30 mg/0.3 mL56.
Step 2 is to calculate the volume to be administered. Since the client is due to receive 30 mg of enoxaparin and the concentration is 30 mg/0.3 mL, the calculation is (30 mg ÷ 30 mg) × 0.3 mL. The final calculated answer is 0.3 mL.
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