A nurse is providing education regarding abnormal signs and symptoms of pregnancy at the client's 20 week appointment.
Which of the following education topics should the nurse include in their teaching?
Report weight gain of 1 pound per week.
Urinary frequency is normal and should only be reported if you have burning.
Report any increase in vaginal discharge or leaking of fluid.
Only report severe nausea and vomiting if it lasts longer than 7 days.
The Correct Answer is C
Choice C rationale
An increase in vaginal discharge or leaking of fluid is an important symptom to report. A sudden increase in watery discharge or a gush of fluid could indicate premature rupture of membranes (PROM), which places both the mother and fetus at risk for infection and premature birth. Reporting this allows for prompt evaluation and appropriate medical intervention to prevent complications.
Choice A rationale
A weight gain of one pound per week during the second and third trimesters is within the normal range. The recommended weight gain is typically 0.5 to 1 pound per week for a woman with a normal BMI. A sudden, rapid weight gain (more than 2 pounds in a week) could be a sign of preeclampsia, which is what the client should be instructed to report.
Choice B rationale
While urinary frequency is normal during pregnancy, especially in the first and third trimesters due to hormonal changes and uterine pressure on the bladder, the client should be instructed to report burning. Burning upon urination is a key symptom of a urinary tract infection (UTI), which is common in pregnancy and can lead to more serious complications like pyelonephritis if left untreated.
Choice D rationale
Severe nausea and vomiting (hyperemesis gravidarum) can lead to dehydration and electrolyte imbalances. Waiting for it to last more than seven days before reporting it is inappropriate. The client should be instructed to report severe nausea and vomiting if it prevents her from keeping fluids down, as this can lead to dehydration and malnutrition, requiring immediate medical attention and potential hospitalization.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","E"]
Explanation
Choice A rationale
While calcium and protein are both vital nutrients during pregnancy, there is no direct scientific link that calcium aids in protein absorption. Protein is broken down into amino acids in the gastrointestinal tract and then absorbed into the bloodstream. Calcium is absorbed through a separate, active transport process that is dependent on vitamin D.
Choice B rationale
Vegan clients can indeed obtain adequate protein from a variety of plant-based sources. Nuts, seeds, beans, lentils, and soy milk are all rich in protein and, when consumed in combination, provide a complete amino acid profile necessary for the synthesis of new proteins for fetal development and maternal tissue growth during pregnancy.
Choice C rationale
Protein is crucial for the formation of new cells and tissues, including muscles, blood, and organs. While protein deficiency can impair bone growth due to its role in the formation of the organic matrix, it is calcium and phosphorus that are the primary mineral components of bones and teeth, providing their rigid structure and strength.
Choice D rationale
Neural tube defects are primarily linked to a deficiency in folic acid (vitamin B9), which is essential for the proper development of the neural tube early in pregnancy. While protein is critical for overall fetal growth and development, its deficiency is not the primary cause of neural tube defects.
Choice E rationale
Protein is a fundamental macronutrient essential for the basic growth and development of the fetus. It provides the necessary amino acids for the synthesis of all fetal tissues, including organs, muscles, blood, and the central nervous system. It also supports the growth of maternal tissues, such as the placenta and uterus.
Correct Answer is ["A","C","F"]
Explanation
Choice A rationale
This is a significant indicator of human trafficking because the trafficker exerts control by preventing the victim from communicating freely. The presence of a third party, often the trafficker, during medical interviews or conversations prevents the victim from disclosing their situation and seeking help without fear of reprisal.
Choice B rationale
Tattoos, piercings, and marijuana use are not definitive signs of human trafficking. These are personal choices and lifestyle factors that are common in various populations and do not, in themselves, indicate exploitation. Basing a suspicion of trafficking on these alone can lead to inaccurate conclusions and misidentification of victims.
Choice C rationale
This is a key sign of human trafficking. A victim living with their employer and not possessing their own identification documents like a license or passport signifies a lack of autonomy and control. The trafficker holds these documents to restrict the victim's movement, prevent them from leaving, and maintain total control over their life.
Choice D rationale
A client being alone and having no support system present is not a direct indicator of human trafficking. Many individuals may present alone to a healthcare setting for various reasons, such as privacy, independence, or lack of local family/friends. While it can be a factor, it is not a primary sign on its own.
Choice E rationale
Living alone and outside of the city area is not a sign of human trafficking. Many individuals choose to live in more rural or isolated locations for personal or financial reasons. This living situation does not inherently suggest that a person is being exploited or held against their will.
Choice F rationale
Providing scripted or rehearsed answers is a common sign of a human trafficking victim. This behavior suggests that the person has been coached by their trafficker on what to say to avoid detection and maintain the narrative. It indicates a lack of spontaneity and genuine communication, signaling a controlled environment.
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