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A nurse is assessing four clients in a prenatal clinic.
Which of the following clients should the nurse recommend that the provider see first?

A.

A client who is at 12 weeks of gestation and reports not having felt the fetus move.

B.

A client who is at 28 weeks of gestation and has a fetal heart rate of 160/min via Doppler.

C.

A client who is at 38 weeks of gestation and has 2+ deep tendon reflexes.

D.

A client who is at 36 weeks of gestation and reports blurred vision.

Answer and Explanation

The Correct Answer is D

Choice A rationale

A client at 12 weeks of gestation not feeling fetal movement is expected. Fetal movement, or quickening, typically begins between 16 and 20 weeks of gestation for primigravidas and earlier for multigravidas. At 12 weeks, the fetus is still small and movements are not usually strong enough to be consistently perceived by the mother, thus this finding is not immediately concerning.

Choice B rationale

A fetal heart rate (FHR) of 160/min at 28 weeks of gestation is within the normal range, which is typically 110-160 beats/min. A normal FHR indicates adequate fetal oxygenation and well-being. Therefore, this finding does not suggest an emergent situation requiring immediate provider assessment.

Choice C rationale

Deep tendon reflexes (DTRs) graded as 2+ are considered normal. This grading indicates an average, brisk reflex response. Abnormal DTRs, such as hyperreflexia (3+ or 4+), can be indicative of preeclampsia, but a 2+ finding is physiological and does not warrant immediate concern.

Choice D rationale

Blurred vision in a client at 36 weeks of gestation can be a symptom of preeclampsia, a serious hypertensive disorder of pregnancy. This condition can lead to severe complications such as eclampsia, placental abruption, or HELLP syndrome, requiring immediate medical evaluation and intervention to prevent adverse maternal and fetal outcomes.


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Related Questions

Correct Answer is C

Explanation

Step 1 is to determine the number of days from April 1 to December 26. Days in April = 30 - 1 + 1 = 30 days. Days in May = 31 days. Days in June = 30 days. Days in July = 31 days. Days in August = 31 days. Days in September = 30 days. Days in October = 31 days. Days in November = 30 days. Days in December = 26 days. Total number of days = 30 + 31 + 30 + 31 + 31 + 30 + 31 + 30 + 26 = 270 days.

Step 2 is to convert the total number of days into weeks. 270 days ÷ 7 days/week = 38.57 weeks.

Step 3 is to round to the nearest whole week. The anticipated gestational age is 39 weeks.

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}

Explanation

The client is at greatest risk for developing Endometritis as evidenced by the client’s Lochia characteristics.

Rationale for correct answers:
Endometritis is a postpartum uterine infection commonly occurring after cesarean birth due to ascending bacterial contamination. The client’s foul-smelling lochia is a hallmark sign, indicating infection of the uterine lining. Normally, lochia is odorless and changes from red to serous and then to white over weeks postpartum. The elevated WBC count (18,000/mm³; normal 5,000–15,000/mm³) supports infection but is nonspecific. The firm uterine tone reduces likelihood of postpartum hemorrhage. Urinalysis positive for bacteria suggests UTI but does not explain uterine signs. Hence, lochia changes are the most direct indicator of endometritis.

Rationale for incorrect Response 1 answers:
Postpartum hemorrhage typically involves heavy bleeding, uterine atony, or a rapidly dropping hematocrit, none of which is reported here. Urinary tract infection is suggested by urinalysis but does not account for uterine tenderness or foul lochia. Deep vein thrombosis would present with limb swelling, pain, and possible fever but no uterine or lochia changes.

Rationale for incorrect Response 2 answers:
Urinalysis positive for bacteria points to UTI but not uterine infection. Elevated WBC count indicates infection or inflammation but lacks specificity for endometritis versus other infections. Uterine tone is firm here, making hemorrhage or uterine atony unlikely and less relevant to infection diagnosis.

Take home points:

  • Endometritis often presents postpartum with foul-smelling lochia and elevated WBC.
  • Foul-smelling lochia is a critical clinical sign distinguishing endometritis from other postpartum complications.
  • Positive urinalysis suggests UTI, a separate postpartum infection that requires differentiation.
  • Uterine tone helps rule out hemorrhage and guides diagnosis of infection versus atony.

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