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A nurse is caring for a client who is at 15 weeks of gestation during a routine prenatal visit.

Exhibits

Which of the following findings should the nurse identify as an indication of a potential complication of pregnancy? Select all that apply.

BUN.

Potassium.

Hct.

Weight.

Heart rate.

Sodium.

Hgb.

Urine-specific gravity

Answer and Explanation

Correct Answer : D,E,H

Choice A rationale:
BUN is within the normal range (10 to 20 mg/dL), so it's not an indication of a potential complication.
Choice B rationale:
Potassium is slightly below the normal range (3.5 to 5 mEq/L), indicating potential hypokalemia, which can be a complication.
Choice C rationale:
Hct is at the upper limit of the normal range (33% to 49%), but still within normal, so it's not a complication.
Choice D rationale:
Weight loss of 2 kg in 1 month during pregnancy is concerning and could indicate a complication such as hyperemesis gravidarum.
Choice E rationale:
Heart rate is slightly elevated, which could indicate dehydration, a potential complication.
Choice F rationale:
Sodium is slightly below the normal range (136 to 145 mEq/L), but this alone is not typically a complication of pregnancy.
Choice G rationale:
Hgb is within the normal range (11 to 16 g/dL), so it's not a complication.
Choice H rationale:
Urine-specific gravity is above the normal range (1.005 to 1.030), indicating potential dehydration, a complication.

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Correct Answer is D

Explanation

Choice A rationale:
Evaluating urinary output is important postoperatively, but it does not address the immediate concern of vaginal bleeding.
Choice B rationale:
Replacing the surgical dressing is necessary if it’s saturated, but it does not address the immediate concern of vaginal bleeding.
Choice C rationale:
Applying an ice pack to the incision site can help reduce swelling and pain, but it does not address the immediate concern of vaginal bleeding.
Choice D rationale:
Administering a 500 mL lactated Ringer’s IV bolus can help increase uterine contractility and decrease bleeding. This is the most appropriate action for the nurse to take in this situation.

A. Remove the diaphragm 2 to 4 hr after intercourse. B. Insert the diaphragm up to 6 hr before intercourse. C. Wash the diaphragm with detergent soap between uses. D. Apply a vaginal lubricant to the diaphragm prior to insertion.

Correct Answer is B

Explanation

Choice A rationale:
Removing the diaphragm 2 to 4 hours after intercourse is incorrect because the diaphragm should be left in place for at least 6 hours after intercourse to prevent pregnancy.
Choice B rationale:
Inserting the diaphragm up to 6 hours before intercourse is correct. This allows time for the spermicide to become effective.
Choice C rationale:
Washing the diaphragm with detergent soap between uses is incorrect. Detergent soap can degrade the material of the diaphragm.
Choice D rationale:
Applying a vaginal lubricant to the diaphragm prior to insertion is incorrect. Lubricants can interfere with the effectiveness of the spermicide.

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A nurse is caring for a client who is at 15 weeks of gestation during a routine prenatal visit. Exhibits Which of the following findings should the nurse identify as an indication of a potential complication of pregnancy? Select all that apply.

Nursing Test Bank

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A nurse is caring for a client who is at 15 weeks of gestation during a routine prenatal visit.

Exhibits

Which of the following findings should the nurse identify as an indication of a potential complication of pregnancy? Select all that apply.