The home health nurse is assessing a 17-year-old pregnant client at 34 weeks of gestation who has been diagnosed with preeclampsia. Upon assessment, the nurse finds that the client has gained 2 pounds in the past week and her blood pressure is 144/92 mmHg. Which assessment finding would require further action by the nurse?

Visual disturbances

Frequent voiding in large amounts

1+ pedal edema

One headache in the past week

Answer and Explanation

The Correct Answer is A

Visual disturbances would require further action by the nurse as they can be a sign of worsening preeclampsia and a potential indication for immediate medical attention. The client's recent weight gain and elevated blood pressure are also concerning findings, but visual disturbances are a more urgent symptom. Frequent voiding in large amounts and 1+ pedal edema are common in pregnancy, while one headache in the past week may or may not be significant depending on the context.

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Correct Answer is B

Explanation

Suprapubic pressure aids in the delivery of the fetal shoulders, and delivery of the fetal head. to control postpartum hemorrhage and to assess uterine tone after delivery.

A. Continue routine prenatal care. B. Be referred to an endocrinologist. C. Be diagnosed with Type II diabetes. D. Be referred to a dietician.

Correct Answer is B

Explanation

In some cases, an endocrinologist may also be involved in the management of gestational diabetes. The nurse can anticipate that the client will be diagnosed with gestational diabetes and will be referred to a dietician for dietary modifications and glucose monitoring during the remainder of her pregnancy. Regular prenatal care will also continue, and the healthcare provider may adjust the treatment plan based on the client's individual needs.

However, a diagnosis of Type II diabetes would not be made solely based on a failed GTT during pregnancy, as gestational diabetes is a temporary condition that usually resolves after delivery.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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