A nurse in a prenatal clinic is caring for a client who believes that she might be pregnant because she feels the baby moving. Which of the following statements should the nurse make?
"This is a probable sign of pregnancy."
"This is a possible sign of pregnancy."
"This is a positive sign of pregnancy."
"This is a presumptive sign of pregnancy."
The Correct Answer is D
Explanation:
A. "This is a probable sign of pregnancy."
A probable sign of pregnancy is an objective finding observed by a healthcare provider that suggests the likelihood of pregnancy but does not confirm it definitively. Examples of probable signs include positive pregnancy tests (urine or blood tests), changes in the uterus (enlargement, softening), and changes in the cervix (Goodell's sign, Chadwick's sign). Sensations of fetal movement, such as the feeling of the baby moving, are actually presumptive signs of pregnancy rather than probable signs because they can have other explanations and are not definitive proof of pregnancy.
B. "This is a possible sign of pregnancy."
While sensations of fetal movement can be associated with pregnancy, they are more accurately classified as presumptive signs rather than possible signs. Possible signs typically refer to signs or symptoms that could be related to various conditions, including pregnancy, but do not specifically indicate pregnancy on their own. In this context, "possible" may not be as accurate as "presumptive" for describing fetal movement as a sign of pregnancy.
C. "This is a positive sign of pregnancy."
A positive sign of pregnancy is a definitive finding that confirms the presence of a fetus. Examples of positive signs include fetal heartbeat heard by Doppler or ultrasound, fetal movement felt by the healthcare provider (palpation), and visualization of the fetus on ultrasound. Sensations of fetal movement reported by the woman (quickening) are not considered positive signs because they can be subjective and may have other explanations, such as gas or muscle contractions.
D. "This is a presumptive sign of pregnancy."
A presumptive sign of pregnancy is a subjective sign reported by the woman that may indicate pregnancy but can also have other explanations. Examples include amenorrhea (missed periods), nausea and vomiting (morning sickness), breast changes, and sensations of fetal movement (quickening). Sensations of fetal movement are considered presumptive because they are subjective and can be caused by factors other than pregnancy, such as gas or muscle contractions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Explanation:
A. Preeclampsia: Preeclampsia is a condition characterized by high blood pressure and signs of damage to other organs, typically occurring after 20 weeks of pregnancy. While preeclampsia is a concern during pregnancy, it is not directly related to abruptio placentae or the development of DIC.
B. Puerperal infection: Puerperal infection refers to an infection that occurs after childbirth. Although infections are a concern in the postpartum period, they are not specifically associated with abruptio placentae or the development of DIC unless there are additional risk factors or complications.
C. Anaphylactoid syndrome of pregnancy: Anaphylactoid syndrome of pregnancy (also known as amniotic fluid embolism) is a rare but serious condition where amniotic fluid enters the maternal circulation, potentially causing a severe allergic-like reaction. This condition is not directly related to abruptio placentae or the development of DIC.
D. Disseminated intravascular coagulation (DIC): This is the correct answer. DIC is a serious condition where the body's clotting mechanisms are abnormally activated, leading to widespread clot formation in small blood vessels. It can result from various conditions, including abruptio placentae, especially when there is evidence of bleeding such as petechiae and bleeding around the IV access site. DIC can lead to both bleeding tendencies and clot formation, affecting multiple organs and potentially causing severe complications.
Correct Answer is C
Explanation
Explanation:
A. "You will need to double your intake of iron during pregnancy."
This statement is not accurate. While iron needs do increase during pregnancy to support the increased blood volume and fetal development, the recommended increase is not necessarily a doubling of intake. Specific iron requirements can vary based on individual factors, such as pre-pregnancy iron status and maternal health conditions.
B. "Prenatal vitamins will meet your need for increased vitamin D during pregnancy."
Prenatal vitamins typically contain some vitamin D, but they may not meet the increased need for vitamin D during pregnancy entirely, especially if the client has limited sun exposure or other risk factors for vitamin D deficiency. Additional sources of vitamin D, such as sunlight exposure and dietary sources, may be recommended.
C. "You will need to increase your calcium intake during breastfeeding."
This statement is correct. During breastfeeding, calcium requirements increase to support milk production and the maintenance of maternal bone health. Adequate calcium intake is important for both the mother and the growing infant.
D. "Vitamin E requirements decline during pregnancy due to the increase in body fat."
This statement is not accurate. Vitamin E requirements do not necessarily decline during pregnancy because of an increase in body fat. Vitamin E is still essential during pregnancy for its antioxidant properties and role in fetal development.
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