A pregnant client at 28 weeks gestation is observed walking with a waddling gait. The nurse explains that this change in walking is a normal part of pregnancy. Which of the following factors is most likely contributing to the client's waddling gait?

Development of scoliosis in the spine

Increased blood volume leading to leg swelling

Relaxation of pelvic ligaments and joints

Increased muscle strength in the lower extremities

Answer and Explanation

The Correct Answer is C

A. Development of scoliosis in the spine: Scoliosis is a lateral curvature of the spine and is not a typical change during pregnancy. Pregnancy usually leads to lumbar lordosis, not scoliosis. This spinal shift affects posture but is not responsible for a waddling gait in pregnancy.

B. Increased blood volume leading to leg swelling: While increased blood volume can cause leg swelling and discomfort, it does not significantly alter the mechanics of walking. Edema may cause heaviness but not the joint instability seen with a waddling gait.

C. Relaxation of pelvic ligaments and joints: Pregnancy hormones like relaxin cause pelvic ligaments and joints to loosen in preparation for childbirth. This increased mobility alters pelvic alignment and stability, leading to the characteristic waddling gait.

D. Increased muscle strength in the lower extremities: Muscle strength typically does not increase during pregnancy; fatigue and reduced endurance are more common. Stronger muscles would improve balance, not cause a waddling gait, making this an unlikely factor.

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Correct Answer is D

Explanation

A. Place the client in knee-chest position: The knee-chest position helps shift the fetus away from the cord, reducing compression. However, it is a supportive measure and should follow immediate manual relief of pressure to protect fetal oxygenation.

B. Prepare the client for an immediate birth: Delivery may be necessary, especially by emergency cesarean section, but this is not the first action. Immediate intervention to relieve cord compression takes priority before surgical preparation.

C. Cover the cord with a sterile, moist saline dressing: Keeping the cord moist helps prevent vasospasm and tissue damage, but this action is secondary to relieving cord pressure. It is supportive, not the first critical intervention.

D. Insert a gloved hand into the vagina to relieve pressure on the cord: This is the priority action to prevent cord compression, which can quickly lead to fetal hypoxia or death. Manual elevation of the presenting part reduces pressure and maintains perfusion until delivery.

A. Continuous fetal monitoring. B. Assess deep tendon reflexes every hour. C. Obtain a daily weight. D. Ambulate twice daily.

Correct Answer is D

Explanation

A. Continuous fetal monitoring: Clients with severe preeclampsia require close fetal surveillance due to the risk of uteroplacental insufficiency. Continuous monitoring helps detect fetal distress or decreased variability. It provides critical information for timely intervention.

B. Assess deep tendon reflexes every hour: Magnesium sulfate, used for seizure prophylaxis in preeclampsia, can cause toxicity. Hourly DTR assessment helps identify early signs of neuromuscular depression. Monitoring reflexes ensures safe medication titration. It also helps track disease severity progression.

C. Obtain a daily weight: Daily weights are essential to evaluate fluid retention, which can indicate worsening preeclampsia. Fluid shifts and edema are common complications that require tracking. Weight changes guide treatment decisions. This is a routine part of preeclampsia management.

D. Ambulate twice daily: Severe preeclampsia often warrants limited activity or bed rest to reduce blood pressure fluctuations. Ambulation may increase the risk of complications like seizures or placental abruption. Activity restrictions help stabilize the maternal condition. Safety is prioritized over mobility.

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A pregnant client at 28 weeks gestation is observed walking with a waddling gait. The nurse explains that this change in walking is a normal part of pregnancy. Which of the following factors is most likely contributing to the client's waddling gait?

Nursing Test Bank

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