The nurse is reviewing fetal and maternal circulation with a group of nursing students. Which statement by a student demonstrates a need for further clarification?

"The placenta is the site of gas exchange for the fetus."

"The umbilical arteries carry deoxygenated blood from the fetus to the placenta."

"The fetal heart pumps blood to both the placenta and the developing organs."

"Maternal and fetal blood mix to allow for nutrient and oxygen exchange."

Answer and Explanation

The Correct Answer is D

A. "The placenta is the site of gas exchange for the fetus."
This is correct because the placenta facilitates oxygen and carbon dioxide exchange between maternal and fetal circulation without direct blood mixing.
B. "The umbilical arteries carry deoxygenated blood from the fetus to the placenta."
This is correct because the two umbilical arteries carry deoxygenated blood from the fetus to the placenta, where gas exchange occurs.
C. "The fetal heart pumps blood to both the placenta and the developing organs."
This is correct because the fetal heart pumps oxygenated blood to its developing organs and sends deoxygenated blood to the placenta for gas exchange.
D. "Maternal and fetal blood mix to allow for nutrient and oxygen exchange."
This is incorrect because maternal and fetal blood do not mix under normal conditions. Instead, nutrients, gases, and waste products pass through the placental barrier via diffusion. If maternal and fetal blood mix, it could indicate a placental rupture or pathological condition.

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Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

Preeclampsia:

Blood pressure of 150/96 mmHg: A BP of ≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive client is diagnostic of preeclampsia.

Preeclampsia with Severe Features:

Blood pressure of 162/112 mmHg: Severe hypertension is ≥160/110 mmHg on two occasions at least 4 hours apart. This is a criterion for severe preeclampsia, requiring immediate intervention to prevent complications like eclampsia or stroke.

Elevated liver enzymes (ALT/AST > 2x the upper limit of normal) are indicative of severe preeclampsia due to hepatic involvement. This can progress to HELLP syndrome, increasing the risk of liver rupture and disseminated intravascular coagulation (DIC).

Neither:

Negative for protein on a urine dipstick: Preeclampsia is typically diagnosed with proteinuria (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3). A negative urine dipstick means proteinuria is absent, making preeclampsia unlikely. However, preeclampsia can also be diagnosed without proteinuria if other systemic features (e.g., thrombocytopenia, renal dysfunction) are present.

Seizures in a client with preeclampsia indicate eclampsia, which is a medical emergency requiring magnesium sulfate to prevent further seizures. If the client had no preeclampsia, the seizures could be due to another cause (e.g., epilepsy, metabolic disturbance).

A. Fetal heart rate (FHR) B. Bowel sounds C. Respiratory rate D. Temperature

Correct Answer is C

Explanation

A. Fetal heart rate (FHR): While FHR monitoring is important, the priority is assessing the mother's respiratory status due to the risk of magnesium toxicity, which can lead to respiratory depression.

B. Bowel sounds: Magnesium sulfate can cause decreased gastrointestinal motility, but bowel sounds are not the immediate priority. The nurse should monitor for paralytic ileus, but respiratory function takes precedence.

C. Respiratory rate: Magnesium sulfate is a central nervous system (CNS) depressant that can cause respiratory depression if levels become too high. A respiratory rate below 12 breaths per minute is a sign of magnesium toxicity, requiring immediate intervention (e.g., stopping the infusion and administering calcium gluconate).

D. Temperature: Temperature is not directly affected by magnesium sulfate administration, making it a lower-priority assessment compared to respiratory rate.

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The nurse is reviewing fetal and maternal circulation with a group of nursing students. Which statement by a student demonstrates a need for further clarification?

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Naxlex Comprehensive Predictor Exams

G1P1, 37 weeks' gestation patient with a scheduled nonstress test (NST) As the nurse, you can identify whether the following findings are indicative of preeclampsia, preeclampsia with severe features, or neither. Select at least one answer in each row.

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"C"}}

Explanation

A nurse is preparing to administer magnesium sulfate IV to a client who is experiencing preterm labor. Which of the following is the priority nursing assessment for this client?

Correct Answer is C

Explanation

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