A 32-week pregnant client presents to the emergency department with vaginal bleeding. The client reports slight vaginal bleeding at 29 weeks, which resolved spontaneously, and now has a recent onset of bright red vaginal bleeding. There are no uterine contractions, the fetal heart rate is within normal range, and the uterus is soft and non-tender. Based on the assessment findings, which condition would the nurse likely suspect?

Preterm labor

Placenta previa

Placental abruption

Vasa previa

Answer and Explanation

The Correct Answer is B

A. Preterm labor: Preterm labor typically presents with regular uterine contractions, cervical changes, and possibly mild bleeding. This client has no contractions or uterine activity, making preterm labor less likely in this scenario.

B. Placenta previa: Placenta previa is characterized by painless, bright red vaginal bleeding in the second or third trimester. The absence of contractions and a soft, non-tender uterus are consistent with this condition. The history of bleeding at 29 weeks further supports this suspicion.

C. Placental abruption: Placental abruption usually presents with painful vaginal bleeding, a firm or tender uterus, and sometimes fetal distress. The lack of uterine tenderness or contractions makes abruption less likely in this case.

D. Vasa previa: Vasa previa involves fetal blood vessels crossing the cervical os and is typically associated with membrane rupture and rapid fetal deterioration. The fetal heart rate is normal, and there’s no mention of ruptured membranes, which makes this diagnosis unlikely.

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Correct Answer is C

Explanation

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.

Correct Answer is ["100"]

Explanation

Answer: 100 gtt/min

Flow rate (gtt/min) = (Total volume per hour (mL/hr) × Drop factor (gtt/mL)) / Time in minutes (min/hr)

Given:

Total volume per hour = 100 mL/hr

Drop factor = 60 gtt/mL

Time in minutes = 60 min/hr

Apply the formula:

Flow rate (gtt/min) = (100 mL/hr × 60 gtt/mL) / 60 min/hr

= 6000 gtt/hr / 60 min/hr

= 100 gtt/min

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Naxlex Comprehensive Predictor Exams

A pregnant client at 28 weeks gestation is observed walking with a waddling gait. The nurse explains that this change in walking is a normal part of pregnancy. Which of the following factors is most likely contributing to the client's waddling gait?

Correct Answer is C

Explanation

A provider prescribes dextrose 5% in water IV to infuse at 100 mL/hr. The drop factor on the manual IV tubing is 60 gtt/mL. The nurse should set the IV flow rate to deliver how many gtt/min?:

Correct Answer is ["100"]

Explanation

A nurse is completing a health history for a client who is at 6 weeks of gestation. The client informs the nurse that she smokes one pack of cigarettes per day. The nurse should advise the client that smoking places the client's newborn at risk for which of the following complications?

A nurse is caring for a client at the first prenatal visit who has an ideal body weight for her height. The client asks how much weight she should gain during pregnancy. Which of the following responses should the nurse make?

A nurse is assessing a pregnant client diagnosed with HELLP syndrome. Which of the following findings is most concerning?

A nurse is caring for a pregnant client who is diagnosed with hyperemesis gravidarum. Which of the following interventions should the nurse prioritize for the pregnant client with hyperemesis gravidarum?

A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not." Which of the following should the nurse recognize as a sign of true labor?

A nurse is educating a newly pregnant client about the stages of pregnancy. The client asks, "Which weeks are included in the first trimester?" The nurse correctly responds with which of the following?

A nurse is caring for an antepartum client whose laboratory findings indicate a negative rubella titer. Which of the following is the correct interpretation of this data?