A nurse is teaching routine prenatal care to a group of clients who are pregnant.
Which of the following statements by a client indicates an understanding of the teaching?

I will be able to hear my baby's heartbeat when I am 6 weeks pregnant.

I will have monthly prenatal visits for the first 28 weeks of pregnancy.

I will have a complete blood count performed at each prenatal visit.

I will have a blood test to check for neural tube defects when I am 32 weeks pregnant.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Fetal cardiac activity is typically detectable via transvaginal ultrasound as early as 5.5 to 6 weeks gestational age, when the embryo is approximately 2-4 mm in crown-rump length. However, hearing the heartbeat with a Doppler stethoscope usually occurs later, around 10 to 12 weeks, as the fetal heart is still very small and sound transmission is limited.

Choice B rationale

The standard schedule for prenatal visits involves monthly appointments from the first prenatal visit until 28 weeks of gestation. This frequency allows for consistent monitoring of maternal and fetal well-being, early detection of potential complications, and timely interventions. After 28 weeks, visits typically become more frequent.

Choice C rationale

While a complete blood count (CBC) is a crucial laboratory test performed during pregnancy, it is not typically done at every prenatal visit. Initial CBCs are obtained at the first prenatal visit to establish baseline values, and then repeated later in pregnancy, often around 28 weeks, to screen for anemia and other hematologic changes.

Choice D rationale

Screening for neural tube defects, often through maternal serum alpha-fetoprotein (MSAFP) testing, is typically performed between 15 and 20 weeks of gestation. This timing is crucial for accurate interpretation of results and allows for further diagnostic evaluation if abnormalities are detected, well before 32 weeks.

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Correct Answer is ["A","B","C"]

Explanation

Choice A rationale

Tachycardia is a common finding in hyperemesis gravidarum due to fluid volume deficit. Significant and persistent vomiting leads to hypovolemia, which triggers a compensatory increase in heart rate to maintain cardiac output and tissue perfusion. The body attempts to compensate for reduced circulating blood volume by increasing the rate at which blood is pumped.

Choice B rationale

Dry mucous membranes are a direct clinical sign of dehydration, which is a hallmark of hyperemesis gravidarum. Prolonged and severe vomiting leads to significant fluid loss, depleting the body's water content. This desiccation is visibly manifested in the oral cavity as dry and sticky mucous membranes, indicating intracellular and extracellular fluid deficit.

Choice C rationale

Poor skin turgor, characterized by skin that remains tented when pinched, is another objective indicator of dehydration. The loss of interstitial fluid due to excessive vomiting reduces the elasticity and plumpness of the skin. This finding reflects a significant depletion of fluid volume within the subcutaneous tissues.

Choice D rationale

Polyuria, meaning excessive urination, is not a typical finding in hyperemesis gravidarum. Instead, severe vomiting and dehydration would lead to oliguria (decreased urine output) as the kidneys attempt to conserve fluid to compensate for the significant fluid losses. The body's priority is fluid retention.

Choice E rationale

Hypertension is generally not associated with hyperemesis gravidarum. Due to significant fluid loss and dehydration, clients with hyperemesis gravidarum are more likely to experience orthostatic hypotension or even profound hypotension as a result of hypovolemia. The decreased circulating blood volume leads to reduced vascular resistance and blood pressure.

A. Teach the client patterned breathing techniques. B. Encourage the support person to perform effleurage. C. Encourage the support person to apply sacral counterpressure. D. Teach the client to use guided imagery.

Correct Answer is C

Explanation

Choice A rationale

Patterned breathing techniques involve conscious control of respiratory rate and depth, which can redirect attention and promote relaxation. This cognitive distraction reduces the perception of pain by engaging higher cortical centers, thus modulating pain signals transmitted via the spinothalamic tracts. However, it does not directly address the localized pressure associated with back labor.

Choice B rationale

Effleurage involves light, circular stroking of the abdomen. This gentle cutaneous stimulation activates large-diameter afferent nerve fibers, which, according to the gate control theory of pain, can inhibit the transmission of noxious stimuli by smaller-diameter fibers in the spinal cord. While soothing, it may not provide sufficient counter-pressure for intense back labor.

Choice C rationale

Sacral counterpressure involves applying firm, sustained pressure to the sacrum. This technique directly opposes the pressure exerted by the fetal occiput against the sacral nerves during back labor. The deep pressure stimulates mechanoreceptors, which can significantly reduce the perception of pain through afferent inhibition and potentially alter the biomechanics of fetal descent.

Choice D rationale

Guided imagery involves directing the client to focus on pleasant mental images to divert attention from pain. This cognitive behavioral strategy can activate descending inhibitory pathways from the brainstem, releasing endogenous opioids and serotonin, thereby modulating pain perception. However, it may not be as effective for the specific, intense pressure of back labor.

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A nurse is teaching routine prenatal care to a group of clients who are pregnant. Which of the following statements by a client indicates an understanding of the teaching?

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who is at 8 weeks of gestation and has hyperemesis gravidarum. Which of the following are findings of this condition? (Select all that apply.)

Correct Answer is ["A","B","C"]

Explanation

A nurse is assessing a client who is in active labor. The client reports back labor pains. Which of the following nonpharmacological interventions should the nurse provide to manage the client's pain?

Correct Answer is C

Explanation

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A nurse is teaching routine prenatal care to a group of clients who are pregnant.
Which of the following statements by a client indicates an understanding of the teaching?