The nurse in a prenatal clinic is assessing a patient who is at 37 weeks' gestation for twins.
The patient reports increased discomfort and increased lower pelvic pressure.
Which action does the nurse take with this patient?

Explains to the patient that increased discomfort is expected with twins.

Performs a digital cervical examination to determine if dilation is occurring.

Sends the patient to the hospital to be checked for possible signs of labor.

After examination, assures the patient of the absence of contractions.

Answer and Explanation

The Correct Answer is C

Choice A rationale

While it’s true that increased discomfort is expected with twins due to additional physical strain and space constraints, this alone is not sufficient reassurance. It is vital to assess for signs of preterm labor or other complications.

Choice B rationale

Performing a digital cervical examination is a valid approach to checking for dilation, but this action must be carefully considered based on other signs and symptoms presented by the patient. The focus here is on ensuring the absence or presence of labor, which might require hospital assessment.

Choice C rationale

Sending the patient to the hospital to be checked for possible signs of labor ensures that professional monitoring and interventions can occur if labor is confirmed. This action prioritizes safety, given the increased risk of complications with twin pregnancies and the advanced gestation of 37 weeks.

Choice D rationale

Assuring the patient of the absence of contractions after an examination might provide temporary relief, but it does not address the possibility of other signs of labor or complications that may require more comprehensive hospital assessment.

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Correct Answer is B

Explanation

Choice A rationale

Decreased muscle tone is not typically associated with neonatal abstinence syndrome (NAS). Instead, NAS often presents with hypertonia or increased muscle tone due to withdrawal symptoms.

Choice B rationale

A continuous high-pitched cry is a hallmark sign of NAS, indicating the newborn is experiencing withdrawal and discomfort. This symptom results from the overstimulation of the central nervous system.

Choice C rationale

Newborns with NAS often have difficulty sleeping and may sleep for shorter periods due to irritability and discomfort. Prolonged sleep after feeding is not characteristic of NAS.

Choice D rationale

Tremors in newborns with NAS are usually pronounced and continuous, not just when disturbed. These tremors are a result of withdrawal effects on the nervous system.

A. PTB is the leading cause of neonatal mortality and for antenatal hospitalization. B. PTBs result in increased numbers of neonatal and infant deaths and long-term neurological impairment. C. PTL is defined as regular uterine contractions resulting in cervical changes before 37 weeks gestation. D. Average costs for premature/low birthweight infants are more than 10 times as high than for other newborns.

Correct Answer is A

Explanation

Choice A rationale

PTB is the leading cause of neonatal mortality and for antenatal hospitalization. This is accurate because preterm birth (PTB) is a significant cause of infant mortality and often requires extended hospital stays for the management of complications.

Choice B rationale

PTBs result in increased numbers of neonatal and infant deaths and long-term neurological impairment. This is accurate because preterm births are associated with higher rates of mortality and long-term health issues in infants.

Choice C rationale

PTL is defined as regular uterine contractions resulting in cervical changes before 37 weeks gestation. This is accurate because preterm labor (PTL) is indeed characterized by these symptoms occurring before full-term pregnancy.

Choice D rationale

Average costs for premature/low birthweight infants are more than 10 times as high than for other newborns. This is accurate because medical care for premature and low birthweight infants is significantly more expensive due to the need for specialized care and extended hospital stays.

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The nurse in a prenatal clinic is assessing a patient who is at 37 weeks' gestation for twins.The patient reports increased discomfort and increased lower pelvic pressure.Which action does the nurse take with this patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is A

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The nurse in a prenatal clinic is assessing a patient who is at 37 weeks' gestation for twins.
The patient reports increased discomfort and increased lower pelvic pressure.
Which action does the nurse take with this patient?