A. Development of scoliosis in the spine: Scoliosis is a lateral curvature of the spine and is not a typical change during pregnancy. Pregnancy usually leads to lumbar lordosis, not scoliosis. This spinal shift affects posture but is not responsible for a waddling gait in pregnancy.

B. Increased blood volume leading to leg swelling: While increased blood volume can cause leg swelling and discomfort, it does not significantly alter the mechanics of walking. Edema may cause heaviness but not the joint instability seen with a waddling gait.

C. Relaxation of pelvic ligaments and joints: Pregnancy hormones like relaxin cause pelvic ligaments and joints to loosen in preparation for childbirth. This increased mobility alters pelvic alignment and stability, leading to the characteristic waddling gait.

D. Increased muscle strength in the lower extremities: Muscle strength typically does not increase during pregnancy; fatigue and reduced endurance are more common. Stronger muscles would improve balance, not cause a waddling gait, making this an unlikely factor.

A. Respiratory rate of 8 breaths per minute: A respiratory rate below 12 breaths per minute is a sign of magnesium toxicity. Magnesium sulfate can depress the central nervous system, and a rate of 8 indicates potential respiratory compromise, requiring immediate intervention and possible discontinuation of the infusion.

B. Urine output of 60 mL in the past two hours: Although slightly low, this output is not yet at the critical level of concern. Urine output should be ≥30 mL/hr to ensure magnesium is excreted effectively. Continued monitoring is needed, but it does not require immediate action.

C. Deep tendon reflexes of +2: A +2 reflex is considered normal and indicates that the client is not currently experiencing neuromuscular depression. Loss or absence of reflexes would be more concerning for magnesium toxicity.

D. Complaints of mild nausea and flushing: These are common and expected side effects of magnesium sulfate therapy. While they should be documented and monitored, they do not suggest toxicity and do not require urgent intervention.

A. 1+ pitting sacral edema: Mild pitting edema is a common clinical feature of preeclampsia, especially in the lower extremities or sacral area due to fluid retention. This finding aligns with expected symptoms and is not inconsistent with the diagnosis.

B. 3+ protein in the urine: Significant proteinuria (≥300 mg/24 hr or ≥1+ on dipstick) is a key diagnostic criterion for preeclampsia. A 3+ result reflects marked protein loss and supports the diagnosis, not contradicts it.

C. Blood pressure 148/98 mm Hg: A systolic pressure ≥140 mm Hg or diastolic ≥90 mm Hg on two readings at least 4 hours apart confirms hypertension in pregnancy. This value fits the diagnostic criteria for preeclampsia.

D. Deep tendon reflexes of +1: Clients with preeclampsia often exhibit hyperreflexia (+3 or +4) due to CNS irritability. A reflex score of +1 is diminished and inconsistent with the expected heightened neuromuscular activity seen in preeclampsia.

A. Positive urine pregnancy test: A positive urine pregnancy test detects hCG but can be influenced by other conditions like trophoblastic disease. It is classified as a probable sign, not a definitive confirmation of pregnancy.

B. Fetal movement felt by the mother: Perception of fetal movement (quickening) is a presumptive sign. It is subjective and can be confused with other sensations, so it is not a reliable indicator of pregnancy.

C. Auscultation of fetal heart tones by Doppler: Hearing fetal heart tones is a positive sign of pregnancy. It provides objective evidence of a fetus, confirming the presence of life inside the uterus and ruling out other conditions.

D. Breast tenderness and enlargement: These are presumptive signs and can occur due to hormonal changes unrelated to pregnancy. They are common in the premenstrual phase and thus not diagnostic on their own.

A. Insert an indwelling urinary catheter: While a catheter may be necessary later for monitoring output or surgical prep, it is not the most urgent need. Ensuring circulatory access to manage potential hemorrhage takes priority over urinary concerns.

B. Witness the signature for informed consent for surgery: Although consent is important if an emergency cesarean becomes necessary, stabilizing the client’s condition first is critical. Legal paperwork should not delay immediate life-saving interventions.

C. Prepare the abdominal and perineal areas: Preparation for surgery may be required, but it is secondary to stabilizing the client. Without IV access, essential fluids, medications, or blood products cannot be administered during active bleeding.

D. Initiate IV access: The client shows signs of possible hypovolemia from bleeding, with tachycardia and low blood pressure. Rapid IV access is the top priority to administer fluids or blood products and support maternal and fetal well-being.

A. There is an elevated level of alpha-fetoprotein (AFP) in the amniotic fluid: Elevated AFP may indicate neural tube defects or abdominal wall defects but is not the defining feature of polyhydramnios. While such defects can coexist with polyhydramnios, elevated AFP is not diagnostic of it.

B. The fetus is likely to have a congenital anomaly, be growth restricted, or demonstrate fetal distress during labor: These are potential complications or associations of polyhydramnios but not the definition itself. The condition refers specifically to excessive amniotic fluid, which may lead to or signal anomalies, not confirm them.

C. The client is carrying more than one fetus: Multiple gestation can cause increased amniotic fluid levels, but polyhydramnios can occur in singleton pregnancies as well. Twin pregnancy is a risk factor, not a definition of polyhydramnios.

D. An excessive amount of amniotic fluid is present: Polyhydramnios is defined as an amniotic fluid index (AFI) greater than 24 cm or a single deepest pocket over 8 cm. This is the most accurate and direct definition of the condition.

A. Place the client in knee-chest position: The knee-chest position helps shift the fetus away from the cord, reducing compression. However, it is a supportive measure and should follow immediate manual relief of pressure to protect fetal oxygenation.

B. Prepare the client for an immediate birth: Delivery may be necessary, especially by emergency cesarean section, but this is not the first action. Immediate intervention to relieve cord compression takes priority before surgical preparation.

C. Cover the cord with a sterile, moist saline dressing: Keeping the cord moist helps prevent vasospasm and tissue damage, but this action is secondary to relieving cord pressure. It is supportive, not the first critical intervention.

D. Insert a gloved hand into the vagina to relieve pressure on the cord: This is the priority action to prevent cord compression, which can quickly lead to fetal hypoxia or death. Manual elevation of the presenting part reduces pressure and maintains perfusion until delivery.

A. The client requires a rubella vaccination at this time: Rubella is a live attenuated virus vaccine and is contraindicated during pregnancy. Administering it during gestation poses a risk of congenital rubella syndrome. The client must wait until after delivery for vaccination. Therefore, immunization now is inappropriate and unsafe.

B. The client requires a rubella immunization following delivery: A negative rubella titer indicates that the client is not immune to rubella and is at risk for infection. Rubella infection during pregnancy can cause serious fetal anomalies. The vaccine should be administered postpartum before discharge. This ensures immunity for future pregnancies.

C. The client is immune to the rubella virus: Immunity is confirmed by a positive rubella titer, not a negative one. A negative result shows susceptibility and lack of protective antibodies. Therefore, this interpretation is incorrect. The client is not immune and needs vaccination after delivery.

D. The client is not experiencing a rubella infection at this time: While a negative titer may imply no current infection, it primarily reflects a lack of immunity. It does not provide diagnostic information about active or recent infection. The main concern here is the absence of antibodies. Thus, this choice misinterprets the titer result.

A. I should report any pain, burning, or itching associated with the vaginal discharge: Pain, itching, or burning are signs of possible infection and should be reported promptly. These symptoms are not typical of normal pregnancy changes. Reporting them helps prevent complications. This statement reflects appropriate understanding.

B. I understand that an increase in vaginal discharge is normal during pregnancy: Hormonal changes during pregnancy lead to increased vaginal secretions. This discharge, known as leukorrhea, is usually clear or white and non-irritating. Recognizing this as normal indicates correct learning.

C. I should be concerned if I experience a white, odorless vaginal discharge: White, odorless discharge is considered normal in pregnancy and does not require concern. Thinking it is abnormal shows a misunderstanding of physiological changes. This indicates a need for further education about normal discharge patterns.

D. My vaginal walls may appear bluish due to increased blood flow: Increased vascularization causes a bluish discoloration of the vaginal mucosa, known as Chadwick’s sign. It is a normal early sign of pregnancy. The client’s awareness of this change reflects accurate knowledge.

A. A client who is at 28 weeks of gestation and reports of painless vaginal bleeding: Painless vaginal bleeding in the second or third trimester may indicate placenta previa, a potentially life-threatening condition. This requires immediate evaluation to assess maternal and fetal well-being. Delayed assessment could result in severe hemorrhage. Therefore, this client is the top priority.

B. A client who has missed a period and reports vaginal spotting: This may suggest early pregnancy or a possible miscarriage, but it is typically less urgent. While the client needs evaluation, it is unlikely to be life-threatening at this stage. This can be triaged after more critical cases are stabilized.

C. A client who is at 38 weeks of gestation and reports a cough and fever: Though a respiratory infection is concerning, it is generally not immediately life-threatening. The client should be assessed for infection and fetal well-being, but it does not override active vaginal bleeding. This client is stable enough to wait a short while.

D. A client who is at 14 weeks of gestation and reports intractable nausea and vomiting: This may indicate hyperemesis gravidarum, which can lead to dehydration and electrolyte imbalance. Although serious, it typically does not pose an immediate threat to life. The condition requires treatment but is not the most urgent in this group.