The nurse identifies the following assessment findings in a client who is 36 weeks' gestation. Which should be immediately reported to the provider?

O negative blood type

Blood pressure 144/94 mm/Hg in left arm

Positive rubella serum antibody titer

Copious leukorrhea

Answer and Explanation

The Correct Answer is B

A. O negative blood type. This is significant for Rh incompatibility if the fetus is Rh-positive, but it is managed through routine prenatal care and does not require immediate intervention at 36 weeks.
B. Blood pressure 144/94 mmHg in left arm. This finding is concerning because it may indicate the development of preeclampsia, which requires immediate medical attention due to the potential risks to both the mother and fetus.
C. Positive rubella serum antibody titer. A positive titer indicates immunity to rubella, which is a good finding in pregnancy and not a concern.
D. Copious leukorrhea. This is common in late pregnancy and typically not a cause for concern unless it is accompanied by signs of infection or rupture of membranes.

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

Explanation

A. Tachypnea. Rapid breathing can indicate respiratory distress associated with heart failure.
B. Wheezes or rales. These are abnormal breath sounds indicating fluid in the lungs, which can occur with heart failure.
C. Bounding pulses. Bounding pulses are not typically associated with heart failure; weak pulses may be present due to poor perfusion.
D. Edematous. Edema can occur due to fluid retention, a sign of heart failure.
E. Difficulty feeding. Poor feeding can result from decreased cardiac output affecting systemic circulation and energy for feeding.
F. Increased comfort laying down. Children with heart failure often prefer sitting upright due to respiratory distress.

A. Chronic fatigue B. Weight gain C. Mood changes D. Weight loss E. Osteoporosis

Correct Answer is ["B","C","E"]

Explanation

A. Chronic fatigue. While chronic fatigue can occur in muscular dystrophy due to muscle weakness, it is not a direct side effect of corticosteroids.
B. Weight gain: Corticosteroids commonly cause weight gain due to increased appetite and fluid retention.
C. Mood changes: Mood swings and changes in behaviour are well-documented side effects of corticosteroid use.
D. Weight loss. Corticosteroids typically cause weight gain rather than weight loss.
E. Osteoporosis: Long-term use of corticosteroids can lead to decreased bone density and osteoporosis, making bone fractures more likely.

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The nurse identifies the following assessment findings in a client who is 36 weeks' gestation. Which should be immediately reported to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which assessment findings would alert the nurse to an infant or child in heart failure? (Select All that Apply.)

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

Explanation

When caring for a 13-year-old with muscular dystrophy receiving corticosteroids to slow disease progression, which of the following medication side effects would you assess for? (Select All that Apply.)

Correct Answer is ["B","C","E"]

Explanation

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