A client in the third trimester of pregnancy reports that she feels some "lumpy places" in her breasts and that her nipples sometimes leak a yellowish fluid. She has an appointment with her healthcare provider (HCP) in two weeks.
Which action should the practical nurse (PN) take?
Recommend that the client wear a supportive bra to prevent leaking of fluid.
Reschedule the client's prenatal appointment for the following day.
Explain that this is normal, but can be assessed further at the next prenatal visit.
Obtain additional data by asking the client if her areolae have become darker.
The Correct Answer is C
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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
The last day of the last normal menstrual period would not accurately establish the estimated date of birth because calculations for gestational age commence from the onset of the cycle. Conception typically occurs around two weeks after the first day, so using the last day would lead to an underestimation of gestational age.
Choice B rationale
The average duration of menstrual periods, while providing insight into cycle regularity, does not offer the precise temporal marker needed for gestational age calculation. Nägele's rule specifically requires the first day of the last menstrual period, not the length of bleeding, to accurately estimate the delivery date.
Choice C rationale
The average frequency of menstrual periods, though indicating cycle regularity or irregularity, is not the specific data point required for estimating the delivery date. Nägele's rule relies on a fixed reference point, which is the beginning of the last menstrual cycle, not the intervals between cycles.
Choice D rationale
The first day of the last normal menstrual period (LMP) is crucial for accurately assigning an estimated date of birth (EDB) using Nägele's rule. This calculation adds 7 days to the LMP and subtracts 3 months, providing a standardized method for determining gestational age and anticipated delivery.
Correct Answer is D
Explanation
Choice A rationale
Impulsive and hyperactive behaviors are typically associated with conditions such as attention-deficit/hyperactivity disorder (ADHD), which involves neurodevelopmental differences affecting executive function and impulse control. While these behaviors can sometimes lead to accidents, they are not a direct sign of secondary enuresis.
Choice B rationale
Involuntary passage of feces, known as encopresis, is a distinct elimination disorder characterized by the repeated passage of stool into inappropriate places, often due to chronic constipation and overflow incontinence. It is a separate condition from enuresis, which specifically refers to involuntary urination.
Choice C rationale
Increased thirst, or polydipsia, is a common symptom of conditions like diabetes mellitus or diabetes insipidus, where the body attempts to compensate for fluid imbalances or high glucose levels. While some medical conditions causing enuresis might also involve increased thirst, it is not a direct sign of enuresis itself.
Choice D rationale
Declining invitations for sleepovers is a behavioral manifestation often observed in children with enuresis. The fear of embarrassment and shame associated with involuntary urination during sleep can lead them to avoid situations where their condition might be exposed, such as overnight stays at friends' houses.
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