A nurse is collecting data from a client who is at 16 weeks of gestation and tells the nurse that she felt light fluttering in her stomach the prior day.
The nurse should use which of the following terms to document this finding?
Quickening.
Lightening.
Braxton Hicks contractions.
Chloasma.
The Correct Answer is A
Choice A rationale:
Quickening is the term used to describe the first noticeable fetal movements felt by the pregnant person. It is often described as a fluttering or bubbling sensation in the lower abdomen.
Quickening typically occurs between 16 and 22 weeks of gestation, with an average of 18 weeks. It is a normal and reassuring sign that the pregnancy is progressing well.
The sensation of quickening is caused by the fetus moving its arms and legs, as well as by its body turning and rotating within the amniotic fluid.
It is important to note that not all pregnant women experience quickening at the same time, and some women may not feel it at all.
However, in this case, the client is at 16 weeks of gestation, which is within the typical timeframe for quickening to occur. Moreover, the client's description of "light fluttering in her stomach" is consistent with the sensation of quickening.
Choice B rationale:
Lightening is the term used to describe the descent of the fetus into the pelvis in preparation for labor.
It typically occurs in the last few weeks of pregnancy, and is often accompanied by a feeling of increased pressure in the pelvis and bladder.
The client in this question is only at 16 weeks of gestation, so it is too early for lightening to have occurred.
Choice C rationale:
Braxton Hicks contractions are irregular, painless contractions of the uterus that can occur throughout pregnancy.
They are often described as a tightening or hardening of the uterus, and they may come and go over a period of several hours. Braxton Hicks contractions are not a sign of labor, but they can sometimes be mistaken for it.
The client in this question did not describe any contractions, so Braxton Hicks contractions are not a likely explanation for her symptoms.
Choice D rationale:
Chloasma is a skin condition that is characterized by brown patches on the face.
It is also known as the "mask of pregnancy" because it is more common in pregnant women. Chloasma is caused by hormonal changes during pregnancy, and it typically fades after delivery.
The client in this question did not describe any skin changes, so chloasma is not a likely explanation for her symptoms
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A: Severe nausea and vomiting
While nausea and vomiting can be common in early pregnancy, including ectopic pregnancies, they are not specific indicators of an ectopic pregnancy.
Approximately 70-80% of pregnant women experience nausea and vomiting, regardless of the location of the pregnancy. Hence, the presence of severe nausea and vomiting alone would not definitively point towards an ectopic pregnancy.
Choice B: Uterine enlargement greater than expected for gestational age
In an ectopic pregnancy, the fertilized egg implants outside the uterus, typically in the fallopian tube. This means the uterus would not be expected to enlarge as it would in a normal intrauterine pregnancy. In fact, uterine size might be smaller than expected for gestational age in cases of ectopic pregnancy.
Choice C: Copious vaginal bleeding
While vaginal bleeding can occur in ectopic pregnancies, it's not always present and is not the most common initial symptom. When bleeding does occur, it's often lighter than a normal menstrual period and may be brown or dark in color.
Copious vaginal bleeding is more likely to occur in cases of miscarriage or other pregnancy complications.
Choice D: Pelvic pain
Pelvic pain is the most common and characteristic symptom of an ectopic pregnancy.
The pain is often described as sharp, stabbing, or cramping, and it may be localized to one side of the abdomen. The pain can be intermittent or constant, and it may worsen with activity or movement.
The pain is caused by the stretching of the fallopian tube as the ectopic pregnancy grows. In some cases, the pain can be severe enough to cause nausea and vomiting.
Therefore, pelvic pain is the most reliable finding that the nurse should expect in a client with a possible ectopic pregnancy at 8 weeks of gestation.
Correct Answer is E
Explanation
Choice A rationale:
Maternal battering, or physical abuse during pregnancy, is a risk factor for placental abruption. However, it is not the most common risk factor. Studies have shown that the incidence of placental abruption is about 2-4 times higher in women who have experienced physical abuse during pregnancy compared to those who have not. However, the overall prevalence of physical abuse during pregnancy is estimated to be around 4-8%, while the prevalence of maternal hypertension is much higher, affecting about 10-15% of pregnancies.
Choice B rationale:
Cigarette smoking is also a risk factor for placental abruption. The nicotine in cigarettes causes vasoconstriction, which can reduce blood flow to the placenta. This can lead to placental abruption, especially in women who smoke heavily. However, while smoking is a significant risk factor, it is still less common than maternal hypertension.
Choice C rationale:
Maternal age is associated with an increased risk of placental abruption. Women over the age of 35 are at a higher risk than younger women. This is likely due to changes in the blood vessels of the uterus that occur with age. However, age alone is not as strong a predictor as hypertension.
Choice D rationale:
Maternal cocaine use is a significant risk factor for placental abruption. Cocaine causes vasoconstriction and can also lead to high blood pressure. This combination of factors can significantly increase the risk of placental abruption. However, cocaine use is much less prevalent than hypertension in the general population.
Choice E rationale:
Maternal hypertension, or high blood pressure during pregnancy, is the most common risk factor for placental abruption. Hypertension can damage the blood vessels in the uterus, which can lead to placental abruption. Approximately 50% of placental abruptions are associated with hypertension.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
