A client at 20 weeks gestation reports discomfort after amniocentesis procedure to the nurse. Which of the following assessment findings warrants priority action by the nurse?

Braxton Hicks contraction

Amniotic fluid contains fetal urine

Prolonged vaginal bleeding

Lab results reveal abnormal chromosome cells

Answer and Explanation

The Correct Answer is C

Explanation:

A. Braxton Hicks contraction

Braxton Hicks contractions are often referred to as "practice" contractions and are common during pregnancy. They are typically irregular and do not cause cervical changes. While discomfort after an amniocentesis procedure can sometimes trigger Braxton Hicks contractions, they are not usually a cause for immediate concern unless they become frequent, intense, or are accompanied by other signs of preterm labor, such as regular contractions, lower back pain, pelvic pressure, or changes in vaginal discharge.

B. Amniotic fluid contains fetal urine

The presence of fetal urine in the amniotic fluid is a normal and expected process during pregnancy. Fetal urine production contributes to the volume and composition of amniotic fluid, helping maintain the environment in the uterus and supporting fetal development. This finding is not directly related to the client's discomfort after an amniocentesis procedure and is not a cause for immediate concern unless there are other complications or abnormalities related to the amniotic fluid composition.

C. Prolonged vaginal bleeding

Prolonged vaginal bleeding after an amniocentesis procedure is a significant finding that requires immediate attention. While some spotting or mild bleeding can occur after the procedure, prolonged or significant bleeding may indicate complications such as uterine injury, placental abruption, or other issues that need urgent assessment and intervention by healthcare providers.

D. Lab results reveal abnormal chromosome cells

Abnormal chromosome cells found in the amniotic fluid sample obtained during amniocentesis may indicate genetic abnormalities or conditions in the fetus. While this finding is significant and requires follow-up and further evaluation, it is not an immediate concern in terms of the client's discomfort or the need for priority action by the nurse unless it is associated with other urgent clinical signs or symptoms.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

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

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

Explanation:

A. The biparietal diameter

The biparietal diameter is a measurement of the fetal head's diameter, which is often assessed during routine prenatal ultrasounds to estimate gestational age and monitor fetal growth. However, in the scenario described, the client is experiencing heavy vaginal bleeding without contractions at 38 weeks of gestation. The focus is on the immediate concern of the fetus's well-being rather than assessing specific fetal measurements like the biparietal diameter.

B. Viability of the fetus

This choice is correct for the scenario described. Viability refers to the ability of the fetus to survive outside the uterus. Heavy vaginal bleeding near term raises concerns about potential harm to the fetus and its viability. An ultrasound would be performed to assess the fetal heart rate, movement, and overall condition to determine if the fetus is viable or if there are any immediate concerns that need to be addressed.

C. Fetal lung maturity

Fetal lung maturity is typically assessed closer to the end of pregnancy, usually around 36 to 39 weeks of gestation, to determine if the fetus's lungs are developed enough for birth. While important for planning deliveries, assessing fetal lung maturity is not the primary concern in a situation where the client is experiencing heavy vaginal bleeding without contractions at 38 weeks of gestation.

D. Location of the placenta

The location of the placenta is important for monitoring placental health and assessing potential complications such as placenta previa. However, in the context of heavy vaginal bleeding without contractions at 38 weeks of gestation, the immediate concern is the well-being and viability of the fetus rather than the placental location.

A. Placenta previa B. Abruptio placentae C. Threatened abortion D. Precipitous labor

Correct Answer is A

Explanation

Explanation:

A. Placenta previa: Placenta previa is a condition where the placenta partially or completely covers the cervix. Painless, bright red vaginal bleeding is a common symptom of placenta previa, especially in the third trimester. This bleeding occurs because the placental blood vessels are disrupted as the cervix begins to dilate or efface during pregnancy.

B. Abruptio placentae: Abruptio placentae is a condition where the placenta detaches from the uterine wall prematurely, leading to painful bleeding. However, the bleeding associated with abruptio placentae is typically dark red and accompanied by uterine pain or contractions. In the scenario described, the bleeding is painless, making abruptio placentae less likely.

C. Threatened abortion: Threatened abortion refers to vaginal bleeding during early pregnancy (before 20 weeks) that may or may not be accompanied by cramping or abdominal pain. It is not typically associated with painless, bright red bleeding at 36 weeks gestation.

D. Precipitous labor: Precipitous labor refers to a rapid labor and delivery process, often completing in less than three hours from onset of contractions to delivery. It is not related to painless, bright red vaginal bleeding.

View Question and Answer

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

A client at 20 weeks gestation reports discomfort after amniocentesis procedure to the nurse. Which of the following assessment findings warrants priority action by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

A nurse is admitting a client who is at 36 weeks gestation and has painless, bright red vaginal bleeding. The nurse should recognize this finding as an indication of which of the following conditions?

Correct Answer is A

Explanation

A nurse in a prenatal clinic is caring for a client who asks what her estimated date of delivery will be if her last menstrual period was July 4, 2020. Which of the following is the appropriate response by the nurse?

A nurse is completing the admission assessment of a client who is at 38 weeks of gestation and has severe preeclampsia. Which of the following is an expected finding?

A nurse on the obstetric unit is caring for a client who experienced abruptio placentae. The nurse observes petechiae and bleeding around the IV access site. The nurse should recognize that this client is at risk for which of the following complications?

A nurse is instructing a woman who is contemplating pregnancy about nutritional needs. To reduce the risk of giving birth to a newborn who has a neural tube defect, which of the following information should the nurse include in the teaching?

The nurse should recognize that which of the following statements most accurately describes the client focus of maternity nursing?

A nurse in a prenatal clinic is teaching a client who is in her second trimester and has a new diagnosis of gestational diabetes. Which of the following statements by the client indicates a need for further teaching?

A nurse is caring for a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from the vagina. Which of the following actions should the nurse perform first?

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?