The nurse is continuing to assist with the care of the client.

Nurses' Notes.

0900: 0930: Client is at 31 weeks of gestation and presents with a severe headache unrelieved by acetaminophen.

Client also reports urinary frequency and decreased fetal movement.

Client is a. gravida 3, para 2 with one preterm birth.

Client reports a constant and throbbing headache and rates their pain as a 6 on a scale of 0 to 10.

Denies visual disturbances.

+3 pitting edema in bilateral lower extremities.

Patellar reflex 4+ without the presence of clonus.

Client reports occasional nighttime leg cramps.

Reports 3 fetal movements within the last 30 min.

External fetal monitor applied with a. baseline FHR 140/min with occasional accelerations and moderate variability.

No uterine contractions noted.

The nurse is reviewing the findings.

For each finding, click to specify if the finding is consistent with preeclampsia or HELLP syndrome.

Each finding may support more than one disease process.

Blood pressure

Hemoglobin

Platelet count

Alanine aminotransferase

Answer and Explanation

The Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"B"},"C":{"answers":"A,B"},"D":{"answers":"B"}}

Blood pressure: This finding is consistent with preeclampsia, but not HELLP syndrome. Preeclampsia is defined as new-onset hypertension (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) after 20 weeks of gestation, with or without proteinuria. HELLP syndrome is a severe form of preeclampsia that involves hemolysis, elevated liver enzymes, and low platelets, but does not necessarily cause hypertension. Hemoglobin: This finding is consistent with HELLP syndrome, but not preeclampsia.

Hemolysis is one of the main features of HELLP syndrome, which causes a decrease in hemoglobin levels. Preeclampsia does not typically affect hemoglobin levels, unless there is significant blood loss or hemodilution.

Platelet count: This finding is consistent with both preeclampsia and HELLP syndrome. Low platelets (thrombocytopenia) are a common complication of preeclampsia, especially in severe cases. They are also a diagnostic criterion for HELLP syndrome, which requires a platelet count of less than 100,000/mm3.

Alanine aminotransferase: This finding is consistent with HELLP syndrome, but not preeclampsia. Elevated liver enzymes are another hallmark of HELLP syndrome, which indicates liver damage and inflammation. Preeclampsia may cause mild elevations of liver enzymes, but not to the same extent as HELLP syndrome.

Nursing Test Bank

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Correct Answer is C

Explanation

Choice A rationale:

A pulled-pork sandwich is not appropriate for a client following a kosher diet, as pork is not considered kosher due to dietary restrictions in Jewish dietary law (kashrut)

Choice B rationale:

Shrimp salad is not suitable for a client following a kosher diet, as shellfish is not considered kosher according to Jewish dietary laws.

Choice C rationale:

Roasted salmon is an appropriate choice for a client following a kosher diet, as salmon is typically considered kosher, provided it has been prepared and cooked according to kosher guidelines.

Choice D rationale:

Clam chowder is not appropriate for a client following a kosher diet, as it contains shellfish (clams), which is not considered kosher in Jewish dietary law.

A. Ice cream. B. Honey. C. Watermelon. D. Yogurt.

Correct Answer is D

Explanation

Choice A rationale:

Ice cream. Ice cream is not typically recommended for individuals with irritable bowel syndrome (IBS) as it contains dairy, which can exacerbate gastrointestinal symptoms in some people with lactose intolerance or dairy sensitivity. It may also be high in sugar, which can worsen IBS symptoms for some individuals.

Choice B rationale:

Honey. Honey is generally well-tolerated by individuals with IBS and can be used as a natural sweetener in moderation. However, it is not specifically recommended as a dietary inclusion for managing IBS symptoms.

Choice C rationale:

Watermelon. Watermelon is a low-fiber fruit that may be well-tolerated by some individuals with IBS, especially during periods of symptom flare-ups. However, it does not provide the beneficial probiotics and digestive enzymes found in yogurt, which can be helpful for some IBS patients.

Choice D rationale:

Yogurt. Yogurt, especially varieties containing live probiotic cultures, can be beneficial for individuals with IBS. Probiotics may help improve gut health and alleviate some gastrointestinal symptoms associated with IBS. It is often recommended as a dietary inclusion for those with IBS.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who follows a kosher diet.Which of the following menu items should the nurse include on the tray?

Correct Answer is C

Explanation

A nurse is assisting a client who has irritable bowel syndrome with meal selections.Which of the following foods should the nurse remind the client to include in her diet?

Correct Answer is D

Explanation

A nurse is assisting with the admission of a client who has tuberculosis with a productive cough.Which type of isolation precautions should the nurse initiate for the client?

A nurse is monitoring an assistive personnel (AP) who is applying elastic antiembolic stockings for a client who has phlebitis. Which of the following actions by the AP indicates that they are performing the skill correctly?

A nurse is assisting with the care of a newborn following a vaginal delivery.Which of the following actions should the nurse perform first?

A nurse is reinforcing teaching with a client who is at 36 weeks of gestation and is about to undergo an amniocentesis.Which of the following information should the nurse include in the instructions?

A nurse is assisting with a community health education program about childhood communicable diseases.Which of the following information should the nurse include in the presentation?

A nurse is contributing to the plan of care for a client who is 2 days postoperative and reports pain in their calf.Which of the following actions should the nurse include?

A nurse is reinforcing teaching with the guardians of a 6-year-old child who has cystic fibrosis.Which of the following information should the nurse include in the teaching?

A nurse is assisting the provider with a lumbar puncture for a client who has manifestations of meningitis.Into which of the following positions should the nurse assist the client?