A nurse has received a change-of-shift report for four clients. Which of the following clients should the nurse identify as being at the highest risk for a complication of pregnancy?
A 30-year-old client who has chronic hypertension.
A 37-year-old client who has a BMI over 30 and is experiencing elevated blood pressure.
A 16-year-old client who is pregnant for the first time.
A 28-year-old client with a history of fetal demise.
The Correct Answer is B
Choice A rationale
Chronic hypertension increases the risk of complications but is not necessarily the highest risk compared to elevated blood pressure and obesity combined in pregnancy.
Choice B rationale
Elevated blood pressure and a high BMI significantly increase the risk for complications like preeclampsia, gestational diabetes, and preterm birth in pregnancy.
Choice C rationale
A 16-year-old pregnant client is at risk due to age, but not as high as the compounded risks of hypertension and obesity.
Choice D rationale
A history of fetal demise increases risk, but current elevated blood pressure and high BMI in an older client present higher immediate pregnancy complication risks.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Multiple gestation increases pregnancy risks but is not directly linked to cervical insufficiency, which involves premature cervical dilation leading to preterm birth or loss without uterine contractions.
Choice B rationale
Advanced maternal age presents various pregnancy risks, including chromosomal abnormalities and hypertension, but is not a primary risk factor for cervical insufficiency, which involves cervical structural issues.
Choice C rationale
A history of preterm labor involves previous early deliveries but does not specifically indicate cervical insufficiency, which is characterized by painless cervical dilation and effacement in the second trimester.
Choice D rationale
Cervical surgery, such as conization or LEEP, can weaken the cervical structure, increasing the risk of cervical insufficiency by reducing the cervix’s ability to remain closed during pregnancy.
Correct Answer is B
Explanation
Choice A rationale
Blood glucose level changes are unrelated to hyperbilirubinemia and phototherapy, which specifically target bilirubin metabolism in the newborn's liver and skin.
Choice B rationale
A decrease in transcutaneous bilirubin (TcB) levels shows effective phototherapy, as it converts bilirubin into water-soluble isomers that can be excreted.
Choice C rationale
Skin color changes from yellow to normal indicate reduced bilirubin levels, but the most accurate measure of phototherapy efficacy is the decrease in TcB levels.
Choice D rationale
Weight gain is not an indicator of effective phototherapy; it reflects overall nutrition and hydration status rather than bilirubin metabolism and excretion.
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