How it Works
Try Naxlex NCLEX-RN (Free-Trial)

The nurse is continuing to care for the client.

Exhibits

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

The client is at greatest risk for developing

and .
Answer and Explanation

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

Rationale for Correct Choices:

  • Seizures: The client presents with severe preeclampsia, indicated by BP >160/110 mm Hg, 3+ proteinuria, hyperreflexia (patellar reflex 4+), and persistent headache. These are strong predictors of progression to eclampsia, which is marked by seizures.
  • Placental Abruption: Severe hypertension increases the risk of placental abruption due to vascular compromise in the uteroplacental circulation. Decreased fetal movement may be an early warning sign of impaired placental perfusion or separation.

Rationale for Incorrect Choices:

  • Cervical Insufficiency: This is a painless cervical dilation often leading to second-trimester loss, unrelated to hypertension or proteinuria. The client is in the third trimester with no signs of cervical changes.
  • Hypoglycemia: The client has no history of diabetes, glucose intolerance, or related symptoms. Her urine glucose was only trace, and no medications suggest insulin use.
  • Heart Failure: No signs of pulmonary congestion, dyspnea, or elevated heart rate are present. Oxygen saturation is normal, and breath sounds are not mentioned as abnormal, making CHF unlikely at this stage.


Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Free Nursing Study Resources

Related Questions

Correct Answer is A

Explanation

Rationale:

A. "I prefer to leave the lights off when I am changing my clothes.": This statement suggests discomfort with the appearance of the body after surgery and a desire to hide it, which reflects an altered body image. Avoiding visual exposure is a common coping mechanism for those struggling with physical changes.

B. "I am ready to join a breast cancer support group.": Willingness to participate in a support group indicates acceptance and proactive coping. It reflects psychological adaptation rather than body image disturbance.

C. "I want to have reconstructive surgery as soon as I can.": Expressing a desire for reconstruction shows future-oriented thinking and a readiness to restore body image, not necessarily an inability to accept the current state.

D. "I understand that my scars will eventually fade.": This statement demonstrates acceptance and understanding of the healing process, indicating a realistic and healthy perception of body changes.

Correct Answer is A

Explanation

Rationale:

A. "Tell me more about how you are feeling about this pregnancy.": This open-ended, therapeutic statement encourages the adolescent to express her thoughts and emotions. It shows empathy and supports trust-building, which is essential in managing anxiety and promoting emotional well-being.

B. "Clients are usually happy about a second pregnancy.": This response generalizes experiences and dismisses the client’s individual feelings. It may cause the client to feel misunderstood or pressured to conform to others' expectations.

C. "You will feel better when you have your first ultrasound.": This statement minimizes the client’s current emotional state and assumes that reassurance will come from a future event, which may not address the underlying anxiety.

D. "Let's focus on how you are feeling physically.": While physical symptoms are important, this response deflects from the client's expressed emotional concern. It can shut down conversation about her psychological well-being, which is the main issue presented.

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Register