A nurse is caring for a client who is at 33 weeks of gestation. The nurse is assessing the client 24 hours later.
How should the nurse interpret the findings?
Hematuria
BUN 40 mg/dL
Leukorrhea
Platelet count 90,000/mm .
The Correct Answer is B
Choice A rationale
Hematuria, or blood in the urine, is not a normal finding in pregnancy. It could indicate a urinary tract infection, kidney stones, or other kidney problems. However, without more information, it’s not possible to determine the significance of this finding in a client who is at 33 weeks of gestation.
Choice B rationale
A BUN (Blood Urea Nitrogen) level of 40 mg/dL is higher than the normal range, which is between 7 and 20 mg/dL17181920. This could indicate that the kidneys are not working properly. However, it could also be due to a high-protein diet, dehydration, or other factors.
Choice C rationale
Leukorrhea, or vaginal discharge, is a common symptom of pregnancy. It is usually thin, white or clear, and mild smelling. If the discharge is yellow, green, or gray, has a strong smell, or is accompanied by itching or burning, it could indicate an infection.
Choice D rationale
A platelet count of 90,000/mm is lower than the normal range, which is between 150,000 and 450,000/mm25. This could indicate a condition called thrombocytopenia, which can be caused by various conditions, including pregnancy25. However, without more information, it’s not possible to determine the significance of this finding in a client who is at 33 weeks of gestation25.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","F"]
Explanation
Choice A rationale
Maintaining a low-stimulation environment is recommended for newborns exhibiting clinical findings of NAS56. This can help to reduce symptoms such as irritability and restlessness.
Choice B rationale
Weighing the newborn daily is important in the care of a newborn with NAS56. This can help to monitor the newborn’s growth and development, and any significant changes in weight could indicate a need for further medical intervention.
Choice C rationale
Advising the parent to avoid breastfeeding is not typically recommended for mothers who used opioids prior to pregnancy and were prescribed methadone during pregnancy. In fact, breastfeeding is often encouraged for these mothers, as it can help to reduce the severity of NAS symptoms in the newborn.
Choice D rationale
Avoiding eye contact with the newborn during feeding is not typically recommended as part of the care for a newborn with NAS56. Eye contact can help to promote bonding between the parent and the newborn.
Choice E rationale
The administration of naloxone is not typically recommended for a newborn with NAS56. Naloxone is a medication used to reverse the effects of opioids, but it is not typically used in the treatment of NAS56.
Choice F rationale
Swaddling the newborn with flexed extremities can help to comfort a newborn with NAS56. This can help to reduce symptoms such as irritability and restlessness.
Choice G rationale
This option is not typically necessary for the management of neonatal abstinence syndrome (NAS). The Ballard score is used to assess gestational age and physical maturity of a newborn, but it is not a routine part of monitoring for NAS.
Correct Answer is C
Explanation
The nurse should provide the instruction to “verify the identity of anyone who wants to remove your baby from the room” in the teaching about security procedures. It is important for parents to be vigilant and ensure that only authorized personnel have access to their baby.
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