A client at 39-weeks gestation presents to labor and delivery with contractions occurring at regular intervals. Her obstetrical history includes a miscarriage at 16-weeks gestation and fetal demise at 31-weeks gestation.
How should the practical nurse (PN) record the client's gravida?
Gravida 4.
Gravida 2.
Gravida 1.
Gravida 3.
The Correct Answer is D
The correct answer is Choice D.
Choice A rationale: This choice incorrectly counts four pregnancies. Scientifically, gravida includes all confirmed pregnancies, but only those that actually occurred. The client has had one miscarriage, one fetal demise, and is currently pregnant—totaling three pregnancies. Counting four would imply an additional pregnancy that did not occur. Overestimating gravida can lead to inaccurate obstetric records and misinterpretation of reproductive history, which may affect clinical decision-making and risk assessment.
Choice B rationale: This choice undercounts the total number of pregnancies by only including two. It likely omits either the miscarriage or the current pregnancy. Scientifically, all pregnancies are counted in gravida, regardless of gestational age or outcome. Miscarriages and fetal demises are included. Underreporting gravida can lead to incomplete obstetric history, which may compromise prenatal care and risk evaluation during labor and delivery.
Choice C rationale: This choice significantly underestimates the gravida by counting only one pregnancy. It may reflect a misunderstanding that only the current or viable pregnancies are included. However, from a clinical standpoint, gravida includes all pregnancies, including those that ended in miscarriage or fetal demise. Accurate gravida documentation is essential for assessing maternal risk factors and planning appropriate obstetric care.
Choice D rationale: This is the correct interpretation. The client has had three pregnancies: one miscarriage at 16 weeks, one fetal demise at 31 weeks, and the current pregnancy at 39 weeks. Scientifically, gravida includes all pregnancies regardless of outcome. This total of three pregnancies makes her gravida 3. Accurate documentation of gravida is crucial for understanding reproductive history and guiding prenatal and intrapartum care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
While wearing a supportive bra can manage symptoms like leaking, it does not address the underlying physiological changes or provide reassurance about their normalcy during pregnancy. The primary concern is to alleviate anxiety and provide accurate information, not just symptom management. Breast changes are common, and this choice does not prioritize assessment or explanation.
Choice B rationale
Rescheduling the appointment prematurely might cause unnecessary anxiety for the client if the symptoms are indeed normal. It disrupts the established prenatal care schedule without sufficient clinical indication. Unless acute distress or clear signs of pathology are present, waiting for the scheduled visit is generally appropriate.
Choice C rationale
During the third trimester, breast tissue undergoes significant hormonal changes in preparation for lactation, leading to increased vascularity, glandular growth, and sometimes the leakage of colostrum, a yellowish fluid. These are normal physiological adaptations, and reassuring the client while noting it for the upcoming visit provides appropriate, evidence-based care.
Choice D rationale
While darkened areolae are another common physiological change during pregnancy due to increased melanocyte-stimulating hormone, asking about it does not directly address the client's current concerns about "lumpy places" or fluid leakage. It's a related but separate observation, and the initial focus should be on explaining the normal changes the client is reporting.
Correct Answer is D
Explanation
Choice A rationale
A soft, spongy fundus, often described as boggy, indicates uterine atony. This condition means the uterine muscles are not contracting effectively, which is abnormal postpartum and significantly increases the risk of postpartum hemorrhage due to inadequate compression of uterine blood vessels.
Choice B rationale
Unilateral lower leg pain, especially accompanied by warmth, redness, or swelling, is an abnormal finding and can be indicative of a deep vein thrombosis (DVT). Postpartum women are at an increased risk for DVT due to hypercoagulability and venous stasis, making this a critical assessment requiring immediate attention.
Choice C rationale
Saturating two perineal pads per hour is an excessive amount of lochia and suggests postpartum hemorrhage. Normal lochia flow should not saturate more than one pad per hour in the immediate postpartum period, indicating that the uterus is not contracting adequately to control bleeding.
Choice D rationale
A heart rate of 56 beats/minute, also known as puerperal bradycardia, is considered a normal physiological finding for a primigravida client 12 hours postpartum. This transient bradycardia often occurs due to the increased stroke volume and cardiac output that result from the significant decrease in uterine blood flow after delivery.
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