During an assessment, a client at 26 weeks of gestation presents with which of the following clinical manifestations that should be reported to the provider?

Correct Answer: D

Rationale: The correct answer is D: Decreased urine output. At 26 weeks of gestation, decreased urine output can be a sign of potential complications like preeclampsia or dehydration, which require immediate medical attention to prevent harm to the mother and baby. Leukorrhea (choice A) is a common pregnancy symptom and not typically concerning. Supine hypotension (choice B) is a known issue in pregnancy but usually occurs later in the third trimester due to pressure on the vena cava when lying on the back. Periodic numbness of the fingers (choice C) can be related to carpal tunnel syndrome, which is common in pregnancy but not typically urgent at 26 weeks unless severe and persistent.

Correct Answer: D

Rationale: The correct answer is D: Pregestational diabetes mellitus. Preeclampsia is a condition characterized by high blood pressure and protein in the urine during pregnancy. Pregestational diabetes is a known risk factor for developing preeclampsia due to the underlying vascular and inflammatory changes associated with diabetes. In contrast, choices A, B, and C are not typically considered risk factors for preeclampsia. A singleton pregnancy (choice A) is a normal occurrence and not a risk factor for preeclampsia. A BMI of 20 (choice B) falls within the healthy weight range and is not a known risk factor for preeclampsia. Maternal age of 32 years (choice C) is also not considered a significant risk factor for preeclampsia in the absence of other factors.

Correct Answer: C

Rationale: The correct answer is C: Shortness of breath. This is because shortness of breath can indicate a potentially serious side effect like a blood clot, which is a rare but serious complication associated with oral contraceptives. Reduced menstrual flow (A) is a common side effect and not typically a cause for concern. Breast tenderness (B) is a common but generally benign side effect of oral contraceptives. Increased appetite (D) is also a common side effect but not typically a sign of a serious complication. Therefore, the healthcare provider should emphasize the importance of reporting shortness of breath promptly.

Correct Answer: C

Rationale: The correct answer is C: Petechiae over the head. This is because tight nuchal cord can cause pressure on the baby's head during delivery, leading to tiny red or purple spots called petechiae due to capillary rupture. Bruising over the buttocks (A) is more common in breech deliveries, hard nodules on the roof of the mouth (B) could indicate Epstein pearls which are benign and common in newborns, and bilateral periauricular papillomas (D) are not related to nuchal cord compression.

Correct Answer: D

Rationale: The correct answer is D: Monitor the fetal heart rate (FHR). After an amniocentesis, the priority is monitoring FHR to assess fetal well-being and detect any signs of distress. This is crucial as the procedure carries a risk of causing fetal distress. Checking the client's temperature (A) is important but not the priority. Observing for uterine contractions (B) is important but not immediate post-amniocentesis. Administering Rho(D) immune globulin (C) is typically done in cases of Rh incompatibility and not directly related to the amniocentesis procedure.

Correct Answer: D

Rationale: Step 1: Betamethasone is a corticosteroid that promotes fetal lung maturity by stimulating the production of surfactant, essential for lung function. Step 2: At 32 weeks, the fetus may benefit from accelerated lung development to reduce respiratory distress. Step 3: Calcium gluconate is used for hypocalcemia, not for fetal lung maturity. Step 4: Indomethacin is a nonsteroidal anti-inflammatory drug used to delay preterm labor, not for lung maturity. Step 5: Nifedipine is a calcium channel blocker to prevent preterm labor, not for fetal lung maturity.

Correct Answer: C

Rationale: The correct answer is C: This is due to the weight of the uterus on the vena cava. Maternal hypotension during pregnancy can occur when the growing uterus compresses the vena cava, reducing blood flow back to the heart and causing a drop in blood pressure. This compression can lead to decreased blood flow to the brain and other vital organs, resulting in symptoms of hypotension. The other choices are incorrect because: A: An increase in blood volume during pregnancy typically leads to an increase in blood pressure, not hypotension. B: Pressure from the uterus on the diaphragm may cause discomfort or shortness of breath but is not the primary cause of maternal hypotension. D: Increased cardiac output is a normal adaptation in pregnancy to meet the demands of the growing fetus and placenta, but it does not directly cause maternal hypotension.

Correct Answer: D

Rationale: The correct answer is D, All of the Above. 1. Decreased fetal movement indicates fetal distress, necessitating CST. 2. IUGR implies potential placental insufficiency, requiring CST evaluation. 3. Postmaturity increases risk of placental insufficiency, warranting CST. Other choices are incorrect as they do not directly indicate the need for CST in a pregnant client.

Correct Answer: A

Rationale: The correct answer is A: Maternal fever. Maternal fever can lead to tachycardia in the fetus due to the transfer of maternal antibodies, cytokines, and other inflammatory mediators across the placenta, affecting fetal heart rate. Maternal fever can indicate infection, which can cause fetal distress. The other choices are incorrect because: B: Fetal heart failure typically presents with bradycardia, not tachycardia. C: Maternal hypoglycemia can affect the fetus but is more likely to cause fetal bradycardia than tachycardia. D: Fetal head compression can result in decelerations but not necessarily tachycardia.