A nurse in the emergency department is caring for a 19-year-old female client who is at 18 weeks of gestation. The client presents with reports of nausea and vomiting for the past several weeks, which has worsened in severity. The client states that she has been unable to retain even clear fluids for the past 48 hours. The client reports no pain but has a history of migraines and asthma.
Exhibits
The Correct Answer is []
• Hyperemesis gravidarum: The client’s symptoms such as severe nausea and vomiting, inability to retain clear fluids, and positive ketones in urinalysis suggest that she is most likely experiencing hyperemesis gravidarum, a pregnancy complication characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance.
• Actions to take: The nurse should administer the prescribed antiemetic medication to help control the client’s nausea and vomiting. The nurse should also provide IV fluid replacement to correct the client’s dehydration and electrolyte imbalance.
• Parameters to monitor: The nurse should monitor the client’s urine output to assess her hydration status. The nurse should also monitor the client’s electrolyte levels, as electrolyte imbalances can occur with severe vomiting and dehydration. If the client’s condition does not improve or worsens, the nurse should notify the healthcare provider immediately.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is choiced. Inform the client about the possible need for reduction of multiple fetuses.
Choice A rationale:
Instructing the client not to use donor oocytes is not accurate.Donor oocytes can be a viable option for clients with certain infertility issues, such as ovarian insufficiency or genetic concerns.
Choice B rationale:
Informing the client that sperm will be introduced to the uterus during ovulation is incorrect.In vitro fertilization involves fertilizing the eggs outside the body in a laboratory setting, not directly introducing sperm into the uterus.
Choice C rationale:
Instructing the client to avoid freezing embryos for possible use in the future is not appropriate.Freezing embryos is a common practice in IVF to allow for future attempts if the initial cycle is unsuccessful.
Choice D rationale:
Informing the client about the possible need for reduction of multiple fetuses is correct.IVF can result in multiple pregnancies, and in some cases, fetal reduction may be recommended to ensure the health and safety of the mother and remaining fetuses.
Correct Answer is D
Explanation
Choice A rationale
A pudendal nerve block is not typically used for postpartum perineal pain management. It is more commonly used during labor to relieve pain in the perineum and vagina.
Choice B rationale
While hydrogel pads can provide cooling relief, they are not typically used for third-degree perineal lacerations. These types of lacerations often require more intensive interventions.
Choice C rationale
Applying a warm pack to the perineum can help with discomfort, but it is not the primary intervention for a third-degree perineal laceration.
Choice D rationale
Witch hazel pads are often recommended for postpartum perineal care. They can provide relief from soreness, reduce inflammation, and promote healing.
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