Which of the following findings in a pregnant client may indicate potential heart failure rather than normal pregnancy changes?

Feeling tired at the end of a busy day

Shortness of breath with moderate exertion

Mild swelling of ankles after standing all day

Swelling of face and hands, rapid breathing, and persistent cough

Answer and Explanation

The Correct Answer is D

A. Fatigue is a common and expected change in pregnancy due to increased metabolic demands and hormonal shifts. It is not specific for heart failure.

B. Mild dyspnea on exertion is common in pregnancy because of increased oxygen demand and diaphragmatic elevation. This alone does not indicate heart failure.

C. Peripheral edema is a typical physiological change in pregnancy, especially in the lower extremities, due to increased blood volume and venous pressure. It is usually not concerning unless accompanied by other signs.

D. These findings are not typical of normal pregnancy and may indicate fluid overload and impaired cardiac function, suggesting heart failure. Pulmonary congestion can cause dyspnea, persistent cough, and orthopnea, while generalized edema (especially in the face and hands) is concerning for cardiac or severe renal involvement.

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Correct Answer is A

Explanation

A. Macrosomia, defined as a birth weight greater than 4,000–4,500 grams, is the most common fetal complication associated with gestational diabetes. Hyperglycemia in the mother leads to increased glucose transfer across the placenta, stimulating fetal pancreatic insulin production. Fetal hyperinsulinemia acts as a growth-promoting hormone, resulting in excessive fat and muscle deposition and ultimately large-for-gestational-age infants. Macrosomia increases the risk of birth injuries such as shoulder dystocia, clavicle fractures, and the need for cesarean delivery.

B. Preterm birth is not the primary risk associated with GDM. While poorly controlled diabetes can contribute to preterm labor, it is less common than macrosomia. The main concern in GDM is excessive fetal growth, not premature delivery.

C. Low birth weight is not typically associated with gestational diabetes. In fact, infants of mothers with poorly controlled GDM are often larger than average, not smaller, due to fetal hyperinsulinemia and increased nutrient availability.

D. Congenital anomalies, particularly neural tube defects or central nervous system defects, are primarily associated with pregestational diabetes rather than GDM. Gestational diabetes develops later in pregnancy (usually after 24 weeks) when organogenesis has largely occurred, so the risk for major congenital anomalies is minimal.

A. The child's behavior indicates a delay in social development rather than temperament. B. The child has a difficult temperament and is unlikely to ever adapt to new environments. C. The child has an easy temperament and adapts quickly to new situations. D. The child has a slow-to-warm-up temperament and requires time to adjust to new experiences.

Correct Answer is D

Explanation

A. The behaviors described including initial clinginess, crying, and gradual adjustment, are typical variations in temperament, not indicators of a social developmental delay. Most 3-year-olds show a range of responses when exposed to new environments.

B. A difficult temperament is characterized by intense reactions, irregular routines, and high sensitivity, but the child in this scenario eventually warms up and engages with others, indicating the child is not persistently difficult.

C. Children with an easy temperament adjust rapidly, show positive mood, and require minimal guidance, which does not match the initial clinginess and crying observed in this child.

D. Slow-to-warm-up children are cautious in unfamiliar situations, may initially withdraw or cling, and gradually adapt once they feel safe. The child’s behavior of crying, clinging, and taking several minutes to engage aligns with this temperament type.

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Which of the following findings in a pregnant client may indicate potential heart failure rather than normal pregnancy changes?

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Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A nurse is assessing a 3-year-old child's response to a new daycare environment. The child initially clings to the parent, cries, and takes several minutes to warm up to other children and new activities. Which statement BEST reflects the child's temperament?

Correct Answer is D

Explanation

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