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?

Leukorrhea.

Excessive salivation.

Darkening of the skin on the face.

Epigastric pain.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Leukorrhea is a common and normal occurrence in pregnancy due to increased estrogen production and greater blood flow to the vaginal area. It is usually a thin, white discharge and not a cause for concern unless accompanied by itching, burning, or an unusual odor.

Choice B rationale

Excessive salivation, also known as ptyalism, can occur during pregnancy, particularly in the first trimester. It is linked to hormonal changes and is not typically harmful, though it may be uncomfortable for the patient.

Choice C rationale

Darkening of the skin on the face, known as melasma or chloasma, is common during pregnancy and is due to increased pigmentation from hormonal changes. It typically resolves postpartum and is not harmful.

Choice D rationale

Epigastric pain in a pregnant client at 33 weeks gestation can be a sign of preeclampsia, a serious condition characterized by high blood pressure and damage to other organs. It requires immediate medical attention to prevent complications for both the mother and baby.

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Correct Answer is D

Explanation

Choice A rationale

Only one dose of rubella immunization is necessary post-delivery, no need for a second dose in 2 weeks.

Choice B rationale

Prevention of pregnancy is recommended for at least 1 month (not 4 months) after receiving the rubella vaccine to avoid possible teratogenic effects.

Choice C rationale

An additional rubella immunization is not recommended during pregnancy as the live vaccine is contraindicated during gestation.

Choice D rationale

Rubella vaccine is safe for breastfeeding mothers, as it does not affect the safety of breast milk.

A. Cool the newborn's heel prior to the procedure. B. Puncture the center of the newborn's heel. C. Cleanse the puncture site with alcohol gauze prior to the procedure. D. Administer vitamin K 30 minutes prior to each blood draw.

Correct Answer is C

Explanation

Choice A rationale

Cooling the newborn’s heel would constrict blood vessels and make it more difficult to obtain a blood sample. Warming the heel is the preferred method to increase blood flow.

Choice B rationale

Puncturing the center of the newborn’s heel is not recommended as it could cause more pain and potential injury to the bone. The puncture should be done on the outer edges of the heel.

Choice C rationale

Cleansing the puncture site with alcohol gauze is essential to reduce the risk of infection and ensure that the sample is not contaminated.

Choice D rationale

Administering vitamin K before each blood draw is unnecessary. Vitamin K is typically given as a one-time dose to prevent bleeding issues, not related to blood draw procedures.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing discharge teaching to a postpartum client who had no immunity to rubella and received the rubella immunization.Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is D

Explanation

A nurse is planning to obtain a blood specimen from a newborn via a heel stick.Which of the following actions should the nurse take?

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?