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The nurse has reviewed the Vital Signs, Nurses' Notes, and Provider Notes from 1 week ago.

Select words from the choices below to fill in each blank in the following sentence.

The client is at risk for developing

and .
Answer and Explanation

The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"B"}

Rationale for correct choices

• Intrauterine growth restriction: The client has experienced persistent nausea and vomiting, reduced oral intake, and a 1.8 kg (4 lb) weight loss over 5 weeks. These factors contribute to maternal malnutrition, which can limit fetal growth and development. Early identification of inadequate maternal nutrition is critical to prevent complications such as low birth weight, preterm birth, and impaired fetal organ development.

• Thiamine deficiency: Prolonged vomiting and poor nutritional intake increase the risk of vitamin deficiencies, particularly thiamine (vitamin B1). Thiamine deficiency in pregnancy can lead to Wernicke’s encephalopathy, neurological complications, and exacerbate maternal fatigue. Prompt recognition and supplementation are essential for both maternal and fetal health.

Rationale for incorrect choices

• Hypernatremia: While dehydration may accompany vomiting, severe vomiting usually leads to hyponatremia and hypokalemia (electrolyte loss) along with metabolic alkalosis. Hypernatremia is less likely than other complications in this scenario, as the client’s main concern is inadequate intake rather than excessive sodium loss.

• Amniotic fluid embolism: Amniotic fluid embolism is an acute, rare obstetric emergency that typically occurs during labor or immediately postpartum. The client’s current presentation in the first trimester does not indicate risk for this condition.

• Chorioamnionitis: Chorioamnionitis is an intrauterine infection usually associated with membrane rupture and labor. There is no report of infection, fever, or membrane compromise in this client. It is not an immediate risk at this stage of pregnancy.


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Related Questions

Correct Answer is ["A","B","D"]

Explanation

Rationale for correct choices

• Migraine headaches with aura: Combined oral contraceptives (COCs) increase the risk of ischemic stroke in individuals with migraine with aura. Estrogen-containing contraception can exacerbate cerebrovascular risk, making it a contraindication regardless of age or other vascular risk factors. Even with good glycemic control, the presence of aura elevates stroke risk significantly.

• History of deep vein thrombosis: COCs increase the risk of venous thromboembolism (VTE). A previous DVT is a strong contraindication because estrogen-containing contraceptives can trigger recurrence. Even if the event occurred years ago, the risk remains elevated, particularly in the presence of other risk factors such as immobility or hypercoagulable states.

• Diabetes mellitus (long-standing): Although the client currently has well-controlled blood sugar (HbA1c 6.7%), the duration of diabetes (24 years) significantly increases the risk of cardiovascular disease. Estrogen-containing contraceptives further elevate cardiovascular and thrombotic risk, making long-standing diabetes a relative contraindication.

Rationale for incorrect choices

• Lifetime nonsmoker / Rare alcohol use: Non-smoking status reduces cardiovascular risk, which is protective rather than contraindicating. Alcohol use in small amounts does not increase risk significantly.

Correct Answer is D

Explanation

A. Irrigate the wound with sterile water: Irrigation may be appropriate after bleeding is controlled, but during active hemorrhage, immediate pressure to control blood loss takes priority over wound cleansing. Delaying hemostasis can lead to hypovolemic shock.

B. Tie a tourniquet around the leg distal to the wound: Tourniquets are reserved for life-threatening hemorrhage when direct pressure fails. Improper placement distal to the wound may be ineffective; tourniquet application should be proximal to the injury if used.

C. Apply a transparent dressing to the wound: Transparent dressings are not suitable for active, profuse bleeding because they do not provide adequate pressure to control hemorrhage. They are more appropriate for observation of healing wounds.

D. Apply direct pressure to the wound with thick dressing material: Direct pressure with sterile or thick dressings is the first-line intervention for controlling active external bleeding. It compresses blood vessels, promotes clot formation, and stabilizes the client until further medical intervention.

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