A nurse in a provider's office is caring for a client who is at 34 weeks of gestation and at risk for placental abruption. The nurse should recognize that which of the following is the most common risk factor for abruption?
Blunt force trauma
Hypertension
Gestational diabetes mellitus
Cigarette smoking
The Correct Answer is B
Choice A reason: Blunt force trauma is a possible risk factor for placental abruption, which is a condition where the placenta detaches from the uterine wall and causes bleeding, pain, and fetal distress. However, blunt force trauma is not the most common risk factor, as it accounts for only a small percentage of cases. The most common causes of blunt force trauma are motor vehicle accidents, falls, or domestic violence.
Choice B reason: Hypertension is the most common risk factor for placental abruption, as it affects about 50% of cases. Hypertension can cause vasospasm and reduced blood flow to the placenta, which can weaken the attachment and lead to separation. Hypertension can be chronic, gestational, or related to preeclampsia.
Choice C reason: Gestational diabetes mellitus is not a risk factor for placental abruption, but rather a condition where the client develops high blood sugar levels during pregnancy and can cause complications, such as macrosomia, polyhydramnios, or neonatal hypoglycemia. Gestational diabetes mellitus does not affect the placental attachment or function.
Choice D reason: Cigarette smoking is a risk factor for placental abruption, as it can cause vasoconstriction and reduced oxygen delivery to the placenta, which can impair its growth and development. However, cigarette smoking is not the most common risk factor, as it affects about 25% of cases.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Respiratory rate is the priority nursing assessment for this client, because magnesium sulfate can cause respiratory depression, which is a life-threatening complication. The nurse should monitor the client's respiratory rate closely, and discontinue the infusion if it falls below 12 breaths per minute.
Choice B reason: Bowel sounds is not a priority nursing assessment for this client, because magnesium sulfate does not have a significant effect on the gastrointestinal system. The nurse should assess the client's bowel sounds as part of the routine physical examination, but it is not a critical parameter for this medication.
Choice C reason: Time of last food intake is not a priority nursing assessment for this client, because magnesium sulfate does not interact with food or affect the absorption of nutrients. The nurse should inquire about the client's dietary intake and preferences, but it is not a vital factor for this medication.
Choice D reason: Temperature is not a priority nursing assessment for this client, because magnesium sulfate does not cause fever or hypothermia. The nurse should measure the client's temperature as part of the vital signs, but it is not a key indicator for this medication.
Correct Answer is A
Explanation
Choice A reason: Asymmetric thigh folds is a common finding in newborns who have DDH, because the affected hip is dislocated or subluxated, causing the thigh to appear shorter and the skin folds to be uneven. The nurse should compare the number and depth of the skin folds on both sides of the groin and buttocks.
Choice B reason: Absent plantar reflexes is not a typical finding in newborns who have DDH, because it is not related to the hip joint. The plantar reflex is a normal reflex that causes the toes to curl when the sole of the foot is stroked. The nurse should assess the plantar reflex in all newborns, regardless of their hip status.
Choice C reason: Lengthened thigh on the affected side is not a usual finding in newborns who have DDH, because the opposite is true. The affected thigh is usually shorter than the unaffected thigh, due to the displacement of the femoral head from the acetabulum. The nurse should measure the length of both thighs from the anterior superior iliac spine to the medial malleolus.
Choice D reason: Inwardly turned foot on the affected side is not a specific finding in newborns who have DDH, because it can be caused by other conditions, such as metatarsus adductus or clubfoot. The inward turning of the foot is not a direct result of the hip disorder, but rather a secondary effect of the abnormal positioning of the leg. The nurse should examine the alignment and mobility of the foot and ankle.
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