A female patient is experiencing nausea, breast tenderness, fatigue, and amenorrhea. Her last menstrual period was 6 weeks ago. The nurse recognizes that this patient is experiencing:
Probable signs of pregnancy.
Positive signs of pregnancy.
Possible signs of pregnancy.
Presumptive signs of pregnancy.
The Correct Answer is D
A. Probable signs of pregnancy: These include objective findings observed by the examiner such as a positive pregnancy test, Hegar’s sign, or an enlarged uterus, not subjective symptoms like nausea and amenorrhea.
B. Positive signs of pregnancy: These are definitive signs such as visualization of the fetus on ultrasound, detection of fetal heart tones, or palpation of fetal movement by the examiner. The client’s symptoms do not confirm pregnancy.
C. Possible signs of pregnancy: This term is not typically used in obstetric classification. The recognized categories are presumptive, probable, and positive signs of pregnancy.
D. Presumptive signs of pregnancy: Subjective symptoms reported by the woman such as nausea, breast tenderness, fatigue, and amenorrhea fall under presumptive signs, since they could also be caused by other conditions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Once the speculum is in the ear, release the traction: Traction on the pinna should be maintained throughout the examination to keep the ear canal straight. Releasing it too soon may obstruct visualization of the tympanic membrane.
B. Use the smallest speculum to decrease the amount of discomfort: The largest speculum that comfortably fits should be used to allow better illumination and visualization. A very small speculum limits the field of view and may compromise accuracy of the assessment.
C. Pull the pinna up and back before inserting the speculum: For adults, pulling the pinna up and back helps straighten the ear canal, making it easier to insert the otoscope and visualize internal structures. This is the correct method for adult ear examination.
D. Tilt the person's head forward during the examination: Tilting the head is not necessary for an otoscopic exam in adults. The essential technique is proper traction on the pinna, not repositioning of the entire head.
Correct Answer is C
Explanation
A. Oval-shaped ovaries: The ovaries are not visualized during a speculum inspection of the vaginal canal. They are located deep within the pelvis and can only be assessed indirectly through bimanual examination or imaging studies.
B. Cervix with an irregular, enlarged os: An irregular or enlarged cervical os is more commonly observed in women who have given birth vaginally. In a nulliparous woman, the cervical os usually appears small and round rather than irregular.
C. Cervix with a smooth, small os: In a 25-year-old patient who has never been pregnant, the expected finding is a smooth cervix with a small, round os. This reflects the absence of prior cervical dilation that typically occurs during childbirth.
D. Pear-shaped uterus: The uterus has a pear shape anatomically, but it is not visualized during a speculum inspection. Only the cervix at the end of the vaginal canal is directly seen with this procedure.
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