Complete the following sentence by using the list of options.
The nurse should recognize the client is experiencing
The Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"B"}
The nurse should recognize that the client is experiencing preterm labor due to previous preterm birth.
Rationale
Option 1: Preterm labor
The client’s symptoms are most consistent with preterm labor. Preterm labor is characterized by regular
uterine contractions before 37 weeks of gestation, cervical dilation and effacement, and sometimes vaginal discharge. In this case, the client has lower back pain, uterine contractions every 8 minutes, cervical dilation of 2 cm, and 50% effacement—all indicative of preterm labor.
Option 2: Previous Preterm Birth
The client's history of a preterm spontaneous vaginal birth at 30 weeks gestation increases the risk of preterm labor in the current pregnancy. The previous preterm birth is a known risk factor for future preterm labor.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. While urine output is important, it is not the most direct indicator of the success of a paracentesis.
B. Comparing the client's weight before and after the procedure helps to evaluate the effectiveness by showing a reduction in fluid buildup.
C. Leakage at the site could indicate a complication, but it is not the primary measure of the procedure’s
effectiveness.
D. Serum albumin levels may be monitored but are not the first indicator of success after a paracentesis.
Correct Answer is A
Explanation
A. Dark yellow urine and low urine output (25 mL/hr) may indicate dehydration or decreased fluid intake, so a fluid bolus is indicated to promote kidney perfusion.
B. Continuous bladder irrigation is typically indicated if there is concern about urinary tract obstruction or blood clots, not for low urine output alone.
C. Clamping the catheter can further hinder urine output and is not indicated.
D. A urine culture and sensitivity might be necessary if infection is suspected, but the priority is to address hydration first.
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