As a nurse in an antepartum unit performing triage, which client should be prioritized?
A client who has missed a menstrual cycle and reports vaginal spotting.
A client who is at 28 weeks of gestation and reports painless vaginal bleeding.
A client who is at 38 weeks of gestation and reports symptoms of a cough and fever.
A client who is at 14 weeks of gestation and reports experiencing nausea and vomiting.
The Correct Answer is B
Choice A rationale
Missing a menstrual cycle and reporting vaginal spotting could indicate early pregnancy or other non-emergency conditions. While this client should be evaluated, it is not the highest priority.
Choice B rationale
A client at 28 weeks of gestation reporting painless vaginal bleeding could be experiencing placenta previa or placental abruption, both of which are obstetric emergencies. This client should be prioritized for immediate evaluation.
Choice C rationale
A client at 38 weeks of gestation reporting symptoms of a cough and fever may have an upper respiratory infection. While this should be evaluated, it is not the highest priority unless the client is in distress.
Choice D rationale
Nausea and vomiting are common in early pregnancy. A client at 14 weeks of gestation reporting these symptoms would need evaluation, but it is not the highest priority.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Cervical dilation is a key sign that a patient is in labor. As labor progresses, the cervix dilates to allow the baby to pass through the birth canal. Other signs of labor can include regular contractions, rupture of membranes (amniotic fluid present in the vaginal vault), and changes in vaginal discharge.
Correct Answer is B
Explanation
Choice A rationale
While cigarette smoking can increase the risk of many complications during pregnancy, including placental abruption, it is not the most common risk factor. Smoking can cause constriction and damage to the blood vessels in the placenta, but other factors, such as hypertension, are more commonly associated with placental abruption.
Choice B rationale
Hypertension is the most common risk factor for placental abruption. High blood pressure can cause damage to the blood vessels in the placenta, leading to abruption. Chronic hypertension, gestational hypertension, and preeclampsia can all increase a woman’s risk of experiencing a placental abruption.
Choice C rationale
Blunt force trauma, such as that experienced in a car accident or a fall, can cause placental abruption, but it is not the most common risk factor. Any trauma to the abdomen during pregnancy should be evaluated by a healthcare provider to assess for potential complications, including placental abruption.
Choice D rationale
Cocaine use can increase the risk of placental abruption. Cocaine causes intense vasoconstriction, which can compromise the blood flow to the placenta and lead to abruption. However, it is not the most common risk factor for this condition.
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