Temp 98.6 (0)
Sp02 98% on RA
What three priority assessments will you make for this patient?
Abdominal girth q 2 hours.
Assess amount of bleeding
Pelvic exam for cervical dilation.
Fetal heart rate patterns
Maternal vital signs
Attach internal fetal scalp electrode.
Correct Answer : B,D,E
A. Abdominal girth is not a primary concern for this patient. Monitoring for signs of abdominal distention and changes in the uterus is more relevant for conditions like preeclampsia or uterine rupture.
B. Assessing the amount of bleeding is essential as vaginal bleeding can indicate serious complications like placental abruption or previa.
C. A pelvic exam is not indicated without signs of cervical change or labor. The priority is to assess for active bleeding and fetal well-being.
D. Fetal heart rate patterns are crucial to assess the status of the fetus, particularly with the concern of placental issues.
E. Maternal vital signs are important to monitor to detect signs of shock or bleeding complications that may not be immediately obvious.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. 3 lbs per week is too high for someone with a BMI of 16 and could lead to excessive weight gain.
B. 35-40 lbs is too broad and may not be suitable for this patient's low BMI, which typically requires a more controlled approach.
C. For a patient with a BMI of 16 (underweight), the recommended weight gain during pregnancy is generally between 28-40 pounds, but given the patient's lower weight, 15-20 lbs is a realistic goal for weight gain, allowing for healthy fetal development.
D. Less than 1lb per week could be too slow, potentially leading to insufficient fetal growth.
Correct Answer is C
Explanation
A. May 1 is not correct; this would be too early by several months.
B. July 8 is not correct; this date is too far out for the due date based on the LMP provided.
C. To calculate the due date using Naegele's rule, you add 7 days to the first day of the last menstrual period (LMP) and then subtract 3 months. Given: LMP: April 15th Step 1: Add 7 days to the LMP: April15th + 7 days= April 22nd Step 2: Subtract 3 months: April22nd – 3 months = January 22nd
D. January 22 is close but not the correct date by the standard calculation of 280 days.
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