The antepartum nurse has just received shift report on four pregnant clients at 0700.Which of the clients should the nurse assess first?

G5 P2202, 32 weeks, placenta previa, today's hemoglobin 11.6 g/dL.

G2 P0101, 39 weeks, type 2 diabetes mellitus (T2DM), fasting blood glucose.

G1 P0000, 32 weeks, partial placental abruption, fetal heart rate (FHR) 120 bpm 15 minutes ago.

G2 P1001, 28 weeks, Rh-negative (Rh-), 1 day post cerclage placement.

Answer and Explanation

The Correct Answer is C

Choice A rationale

The hemoglobin level of 11.6 g/dL is within the normal range for a pregnant woman. While placenta previa requires monitoring, it is not immediately life-threatening.

Choice B rationale

Type 2 diabetes mellitus requires regular monitoring and management, but a single fasting blood glucose level does not indicate an immediate emergency unless it is extremely high or low.

Choice C rationale

Partial placental abruption can lead to significant complications for both the mother and fetus, including hemorrhage and fetal distress, making it the priority for immediate assessment.

Choice D rationale

An Rh-negative status and a recent cerclage placement are important for ongoing monitoring but do not present an immediate life-threatening condition that demands the first assessment.

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Correct Answer is B

Explanation

Choice A rationale

While infection prevention is vital, ensuring breathing function is more critical after ASP.

Choice B rationale

ASP affects the respiratory system severely; thus, restoring normal breathing is a primary goal.

Choice C rationale

Gastrointestinal function is less immediately affected by ASP compared to respiratory issues.

Choice D rationale

Voiding without pain is important, but respiratory stability takes precedence.

A. Contraction duration of less than 40 seconds. B. Contraction frequency of greater than 5 in 10 minutes. C. Contraction intensity of less than 80 mm Hg. D. Resting tone of less than 18 mm Hg.

Correct Answer is B

Explanation

Choice A rationale

Contraction duration less than 40 seconds doesn't define tachysystole. Tachysystole focuses on frequency, not duration, of contractions over a specific time frame.

Choice B rationale

Contraction frequency of more than 5 in 10 minutes defines tachysystole. This frequency indicates excessive uterine activity, requiring intervention to prevent fetal distress.

Choice C rationale

Contraction intensity less than 80 mm Hg does not define tachysystole. Intensity relates to contraction strength, but tachysystole is about frequency exceeding the normal range.

Choice D rationale

Resting tone less than 18 mm Hg isn't part of tachysystole's definition. Tachysystole pertains to contraction frequency, not resting tone, which measures uterine relaxation between contractions.

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The antepartum nurse has just received shift report on four pregnant clients at 0700.Which of the clients should the nurse assess first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following is the appropriate nursing care outcome for a client who suddenly develops anaphylactoid syndrome of pregnancy (ASP) during labor?

Correct Answer is B

Explanation

Included in the definition of tachysystole is:

Correct Answer is B

Explanation

During a vaginal delivery, the obstetrician declares that a shoulder dystocia has occurred.Which of the following actions by the nurse is appropriate at this time?

The nurse observes a new staff member caring for an eclamptic client following a seizure.Which of the following actions by the staff member indicates an understanding of eclampsia?

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Postpartum endometritis is:

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