The nurse has admitted a client who is 30 weeks gestation with suspected intrauterine growth restriction. The physician has ordered a Doppler blood flow study. What does the nurse suspect if the results show an S/D ratio above the 95th percentile for the gestational age, a ratio above 3, or end-diastolic blood flow that is absent or reversed?

Correct Answer: B

Rationale: The correct answer is B: Placental insufficiency. An elevated S/D ratio (>95th percentile for gestational age or >3) and absent/reversed end-diastolic blood flow on Doppler study indicate impaired placental blood flow, leading to decreased oxygen and nutrient delivery to the fetus. This can result in intrauterine growth restriction (IUGR) and compromise fetal well-being. Decreased blood pressure (A) is not directly related to these Doppler findings. Increased amniotic fluid (C) is more commonly associated with conditions like fetal anomalies or maternal diabetes. Decreased fetal movement (D) may be a sign of fetal distress but is not specifically indicated by Doppler findings in IUGR.

Correct Answer: B

Rationale: The correct answer is B: Change maternal position. This is the highest priority because the client is experiencing recurrent variable decelerations, which can indicate umbilical cord compression. Changing the maternal position can help relieve the pressure on the cord, potentially improving fetal oxygenation. Administering oxygen (choice A) can be important but addressing the cause of the variable decelerations is crucial. Performing fetal scalp stimulation (choice C) is not appropriate at this time as the focus should be on improving fetal oxygenation. Performing a vaginal examination (choice D) is not necessary at this moment and may even exacerbate the situation.

Correct Answer: D

Rationale: The correct answer is D because in the first trimester, regular monitoring is crucial to ensure the health and well-being of both the mother and fetus. Visiting every 4 weeks allows the healthcare provider to monitor the progress of the pregnancy, detect any potential issues early on, and provide appropriate interventions if needed. This frequency enables timely adjustments to care plans, such as dietary recommendations or medication changes, to optimize outcomes. Choices A, B, and C are incorrect as they do not directly relate to the primary reason for the regular visits during the first trimester, which is to monitor the conditions of the expectant mother and fetus.

Correct Answer: C

Rationale: The correct answer is C: 2, 1. Gravida refers to the total number of pregnancies, including the current one. The patient delivered triplets 2 years ago, so she is currently pregnant again, making her total pregnancies 2. Para refers to the number of deliveries after 20 weeks of gestation, regardless of the number of fetuses. Since she delivered triplets 2 years ago, she had 1 delivery after 20 weeks of gestation, making her para 1. Choices A, B, and D are incorrect as they do not accurately reflect the patient's obstetric history based on the information provided.

Correct Answer: A

Rationale: The correct answer is A: Abdominal pain. This complaint at 35 weeks of gestation requires additional assessment as it could indicate a serious issue such as preterm labor, placental abruption, or other complications. Abdominal pain in late pregnancy should never be ignored. Ankle edema in the afternoon, backache with prolonged standing, and shortness of breath when climbing stairs are common discomforts in pregnancy and may not necessarily indicate a serious problem at this stage.