A nurse is assessing a client who is at 33 weeks of gestation.
Which of the following findings should the nurse report to the provider?

Epigastric pain.

Leukorrhea.

Excessive salivation.

Darkening of the skin on the face.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Epigastric pain in a pregnant client, especially at 33 weeks gestation, can be a symptom of preeclampsia, a serious hypertensive disorder of pregnancy. This pain may indicate hepatic involvement and impending eclampsia, requiring immediate medical evaluation to prevent severe maternal and fetal complications.

Choice B rationale

Leukorrhea, an increase in vaginal discharge, is a common physiological finding during pregnancy due to increased estrogen levels and blood flow to the vaginal area. It is typically thin, white, and odorless, and does not generally require reporting unless accompanied by itching, odor, or color changes.

Choice C rationale

Excessive salivation, or ptyalism, is a common and benign complaint during pregnancy, often attributed to hormonal changes. While bothersome, it does not indicate a pathological condition and is not a finding that requires reporting to the provider.

Choice D rationale

Darkening of the skin on the face, known as chloasma or melasma gravidarum, is a normal physiological change in pregnancy caused by increased melanin production due to hormonal fluctuations. It is a cosmetic issue and not indicative of a medical concern requiring provider notification.

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Correct Answer is C

Explanation

Choice A rationale

Patterned breathing techniques involve conscious control of respiratory rate and depth, which can redirect attention and promote relaxation. This cognitive distraction reduces the perception of pain by engaging higher cortical centers, thus modulating pain signals transmitted via the spinothalamic tracts. However, it does not directly address the localized pressure associated with back labor.

Choice B rationale

Effleurage involves light, circular stroking of the abdomen. This gentle cutaneous stimulation activates large-diameter afferent nerve fibers, which, according to the gate control theory of pain, can inhibit the transmission of noxious stimuli by smaller-diameter fibers in the spinal cord. While soothing, it may not provide sufficient counter-pressure for intense back labor.

Choice C rationale

Sacral counterpressure involves applying firm, sustained pressure to the sacrum. This technique directly opposes the pressure exerted by the fetal occiput against the sacral nerves during back labor. The deep pressure stimulates mechanoreceptors, which can significantly reduce the perception of pain through afferent inhibition and potentially alter the biomechanics of fetal descent.

Choice D rationale

Guided imagery involves directing the client to focus on pleasant mental images to divert attention from pain. This cognitive behavioral strategy can activate descending inhibitory pathways from the brainstem, releasing endogenous opioids and serotonin, thereby modulating pain perception. However, it may not be as effective for the specific, intense pressure of back labor.

A. "It is important to gain 2 pounds per week throughout the rest of your pregnancy.”. B. "You can cause problems for your baby if you try to diet while pregnant.”. C. "It would be helpful for us to meet with the dietitian to see how they can help you meet and assess your nutritional needs.”. D. "You should eat an additional 700 calories per day while you are pregnant.”.

Correct Answer is C

Explanation

Choice A rationale

While weight gain is crucial during pregnancy, a blanket statement of 2 pounds per week is not universally appropriate. The recommended rate of weight gain varies based on the client's pre-pregnancy BMI and the trimester. Excessive or insufficient weight gain can lead to adverse maternal and fetal outcomes, including macrosomia or intrauterine growth restriction, highlighting the need for individualized nutritional guidance rather than a fixed weekly gain.

Choice B rationale

Dieting during pregnancy, especially restrictive calorie intake, can significantly compromise the nutrient supply to the developing fetus. Fetal growth and organogenesis are highly dependent on adequate maternal nutritional stores and daily nutrient intake. Inadequate nutrition can lead to low birth weight, premature birth, and long-term health complications for the infant, emphasizing the dangers of unguided dietary restrictions.

Choice C rationale

A dietitian possesses specialized knowledge in medical nutrition therapy and can provide personalized recommendations based on the adolescent's specific nutritional needs, gestational age, and pre-pregnancy weight. This collaborative approach ensures optimal maternal and fetal health by addressing any deficiencies, managing appropriate weight gain, and promoting healthy eating habits throughout the pregnancy, which is crucial for adolescent development and pregnancy outcomes.

Choice D rationale

The caloric needs of a pregnant adolescent increase in the second and third trimesters, but a fixed additional 700 calories per day may not be accurate for all individuals. Caloric requirements are dynamic and depend on pre-pregnancy weight, activity level, and the specific stage of gestation. Overestimation can lead to excessive weight gain, while underestimation can result in inadequate fetal growth, necessitating individualized assessment.

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A nurse is assessing a client who is at 33 weeks of gestation. Which of the following findings should the nurse report to the provider?

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Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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A nurse is assessing a client who is at 33 weeks of gestation.
Which of the following findings should the nurse report to the provider?