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A nurse is caring for a client who is at 36 weeks of gestation.

Exhibits

For each day 2 finding, click to specify whether the finding indicates that the client's condition has improved, has not changed, or has declined.

A.

Liver function tests

B.

Edema

C.

Fetal heart rate and variability

D.

Headache

E.

Epigastric discomfort

F.

Urine dipstick

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"C"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"B"}}

  • Liver Function Tests: Improved
    The significant decrease in AST, ALT, ALP, and bilirubin levels indicates improved liver function.

  • Edema: Improved
    The reduction from +3 to +2 edema in the lower extremities shows a decrease in swelling, indicating improvement.

  • Fetal Heart Rate and Variability: Declined
    The decrease in FHR with minimal variability and no accelerations suggests a decline in fetal status.

  • Headache: Improved
    The reduction in headache pain from a score of 8 to 2 indicates improvement.

  • Epigastric Discomfort: Improved
    The absence of epigastric pain on Day 2 suggests improvement.

  • Urine Dipstick: Not Changed
    The protein levels in the urine remained at 2+ on both days, indicating no change in kidney function.


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Related Questions

Correct Answer is D

Explanation

Rationale:

A. Asking a psychiatrist to talk with the parents may not be the most appropriate immediate

action when abuse is suspected. Reporting to the authorities should take precedence to ensure the child's safety.

B. Obtaining a detailed history is important but should be done after reporting the suspected abuse to the authorities.

C. Separating the child from the parents may not be feasible or appropriate in all situations.

Reporting to the authorities is the priority action to ensure proper investigation and protection of the child.

D. Report the suspected abuse to the authorities. Suspected child abuse must be reported

immediately to the appropriate authorities, such as child protective services or law enforcement, for further investigation and intervention to ensure the safety and well-being of the child.

Correct Answer is C

Explanation

Rationale:

A. Panting may be indicated if pushing is premature, but the sudden urge to push suggests the need to assess for crowning.

B. While assisting the client into a comfortable position may be appropriate, it's essential to first assess for signs of imminent delivery.

C. This action is crucial to determine if the client is fully dilated and ready for delivery.

D. Helping the client to void may relieve pressure on the bladder but does not address the sudden urge to push, which may indicate imminent delivery.

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