The nurse is caring for a pregnant client with a diagnosis of gestational diabetes. What finding indicates the need for immediate intervention?

Correct Answer: C

Rationale: In the context of caring for a pregnant client with gestational diabetes, the finding that indicates the need for immediate intervention is the presence of ketones in the urine (Option C). Ketones in the urine suggest that the body is breaking down fats for energy due to inadequate insulin levels, which can lead to diabetic ketoacidosis, a serious condition that requires prompt medical attention to prevent maternal and fetal complications. Option A, a blood sugar of 130 mg/dL after a meal, is within the target range for postprandial glucose levels in gestational diabetes management. Option B, a fasting blood sugar of 95 mg/dL, although slightly low, is not a critical finding requiring immediate intervention. Option D, the client reporting increased thirst, is a symptom of hyperglycemia but does not indicate an urgent need for intervention compared to the presence of ketones, which signals a more severe metabolic imbalance. Educationally, understanding the significance of ketones in gestational diabetes is crucial for nurses to provide timely and appropriate care to pregnant clients. Recognizing the signs of diabetic ketoacidosis can help prevent maternal and fetal complications, emphasizing the importance of close monitoring and prompt intervention in the management of gestational diabetes.

Correct Answer: C

Rationale: In a prenatal class, it is crucial for the nurse to accurately educate expecting mothers about the physiological changes they may experience during pregnancy. The correct answer, option C, darkening of the areola, is expected during pregnancy due to increased estrogen levels which stimulate melanocyte-stimulating hormone, leading to hyperpigmentation. This change is important as it helps the newborn locate the breast for feeding after birth. Option A, decrease in nipple pigmentation, is incorrect as nipple pigmentation often darkens during pregnancy. Option B, reduction in breast size, is also incorrect as breast size typically increases in preparation for lactation. Option D, development of inverted nipples, is incorrect as this is not a common change during pregnancy but rather a preexisting condition in some individuals. Understanding these expected breast changes is essential for pregnant women to alleviate concerns and prepare for breastfeeding. Educating them about these changes empowers them to embrace the journey of motherhood with confidence and knowledge.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Occiput posterior fetal position. This position refers to the baby facing the mother's abdomen with the back of the head against her spine, which can lead to intense back pain during labor. Option B) Placental abruption involves the detachment of the placenta from the uterine wall, leading to vaginal bleeding and fetal distress, but it is not directly related to back pain. Option C) Breech presentation occurs when the baby's buttocks or feet are positioned to come out first, which can cause discomfort but not specifically intense back pain. Option D) Uterine rupture is a serious complication where the uterus tears during labor, causing severe pain and distress, but it is not typically associated with back pain. Educationally, understanding fetal positions and their implications in labor is crucial for nurses and midwives to provide appropriate care and support to laboring mothers. Recognizing the impact of fetal position on the mother's pain can guide interventions to improve labor progress and comfort.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Placenta previa. Placenta previa is a condition where the placenta partially or completely covers the cervix, leading to painless vaginal bleeding, especially in the third trimester. This condition is associated with no uterine tenderness or contractions, which aligns with the client's presentation of mild vaginal bleeding and no pain at 35 weeks' gestation. Option A) Abruptio placentae involves the premature separation of the placenta from the uterine wall, leading to painful bleeding. This condition is usually associated with uterine tenderness and contractions, which are absent in the client's case. Option C) Preterm labor involves regular uterine contractions leading to cervical changes and can manifest with vaginal bleeding. However, in this case, the lack of pain and the absence of contractions make preterm labor less likely. Option D) Urinary tract infection is unrelated to the symptoms described by the client and does not present with vaginal bleeding in the absence of other complications. Educationally, understanding the differences between placenta previa, abruptio placentae, preterm labor, and unrelated conditions like urinary tract infections is crucial for nurses caring for pregnant clients. Recognizing the signs and symptoms of each condition is essential for prompt identification, intervention, and ensuring the best outcomes for both the mother and the baby.

Correct Answer: B

Rationale: In the context of pharmacology and maternal newborn health, understanding the signs and symptoms of chorioamnionitis is crucial for nurses to provide timely and appropriate care to pregnant clients. Chorioamnionitis is an infection of the fetal membranes and amniotic fluid that can occur with prolonged rupture of membranes during labor. The correct answer is B) Foul-smelling vaginal discharge. This finding suggests chorioamnionitis because the infection can cause a foul odor due to the presence of bacteria in the amniotic fluid and vaginal discharge. This sign is indicative of an intrauterine infection that requires immediate medical attention to prevent complications for both the mother and the fetus. Option A) Clear amniotic fluid is incorrect because chorioamnionitis typically presents with cloudy or purulent amniotic fluid due to the infection. Option C) Fetal heart rate of 140 beats/minute is a normal fetal heart rate and not specific to chorioamnionitis. Option D) Absence of maternal fever is also incorrect because maternal fever is a common symptom of chorioamnionitis, and its absence does not rule out the presence of the infection. In an educational context, nurses need to be able to recognize the signs and symptoms of chorioamnionitis to initiate prompt interventions such as antibiotics and possibly expedited delivery to prevent maternal and neonatal complications. This knowledge is essential for providing safe and effective care to pregnant clients during labor and birth.