A nurse in a prenatal clinic is caring for a client who reports that her menstrual period is 2 weeks late. The client appears anxious and asks the nurse if she is pregnant. Which of the following responses should the nurse make?

"You can miss your period for several other reasons. Describe your typical menstrual cycle

"If you have been sexually active and haven't used protection it is likely that you are pregnant

"Let's check to see if you have any other signs of pregnancy. Have you noticed any abdominal enlargement yet?

"Because you have missed your period, you should try taking a home pregnancy test before you start worrying

Answer and Explanation

The Correct Answer is A

Choice A Reason:

"You can miss your period for several other reasons. Describe your typical menstrual cycle." This response acknowledges that a missed period can result from various factors other than pregnancy, such as stress, changes in weight, hormonal fluctuations, or certain medical conditions. Understanding the client's typical menstrual cycle can help the nurse gather more information about potential reasons for the late period.

Choice B Reason:

"If you have been sexually active and haven't used protection, it is likely that you are pregnant. “This response assumes pregnancy without exploring other possibilities or the client's individual situation.

Choice C Reason:

"Let's check to see if you have any other signs of pregnancy. Have you noticed any abdominal enlargement yet?" While considering other signs of pregnancy is reasonable, focusing on abdominal enlargement may not be the most accurate early indicator, and it's essential to explore a broader range of symptoms.

Choice D Reason:

"Because you have missed your period, you should try taking a home pregnancy test before you start worrying. "While suggesting a home pregnancy test is reasonable, it may be more beneficial to gather additional information about the client's menstrual cycle and potential symptoms before jumping directly to a test.

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Correct Answer is C

Explanation

A. The pattern of contractions is important in assessing labor, but the presence of regular contractions alone does not confirm true labor. It is the changes in the cervix that indicate progress in labor.

B. The station of the presenting part (the level at which the baby's head has descended into the pelvis) is also a factor in labor, but it is not the primary indicator of true labor. Changes in the cervix are more indicative.

C. Changes in the cervix are a key sign of true labor.

True labor involves cervical effacement (thinning) and dilation (opening). These changes in the cervix signify progress in the labor process.

D. Rupture of the membranes (water breaking) can be a sign of labor, but it doesn't confirm true labor on its own. It might occur before, during, or after labor has begun.

A. "This medication will stop your labor" B. "This medication stimulates fetal lung maturity" C. "This medication will decrease your risk for uterine infections" D. "This medication will increase your baby's weight"

Correct Answer is B

Explanation

A. "This medication will stop your labor": Betamethasone is not intended to stop labor. It is given to promote fetal lung maturity and reduce the risk of complications associated with preterm birth.

B. "This medication stimulates fetal lung maturity": This is the correct statement. Betamethasone is administered to enhance the production of surfactant in the fetal lungs, improving respiratory outcomes for the preterm infant.

C. "This medication will decrease your risk for uterine infections": Betamethasone does not directly decrease the risk of uterine infections. Its primary benefit is in promoting fetal lung maturity.

D. "This medication will increase your baby's weight": Betamethasone is not given to increase the baby's weight. Its main focus is on improving lung function and reducing respiratory complications in preterm infants.

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A nurse in a prenatal clinic is caring for a client who reports that her menstrual period is 2 weeks late. The client appears anxious and asks the nurse if she is pregnant. Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not. Which of the following should the nurse recognize as a sign of true labor?

Correct Answer is C

Explanation

A nurse is caring for a client who is experiencing preterm labor at 29 weeks of gestation and has a prescription for betamethasone. Which of the following statements should the nurse make about the indication for medication administration?

Correct Answer is B

Explanation

A nurse is caring for a client who is scheduled to receive intravenous oxytocin for the induction of labor. The client has a Bishop score of 8 which of the following findings should the nurse expect?

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A nurse is caring for a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from the vagina. Which of the following actions should the nurse perform first?

A nurse is caring for a client who is in active labor when the client's membranes rupture. The fetal monitor tracing shows late decelerations Which of the following actions should the nurse take first?

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