The nurse is caring for a pregnant patient who is 37 weeks gestation and is experiencing contractions every 10 minutes. Which of the following should the nurse assess first?

Correct Answer: B

Rationale: The correct answer is B: The patient's cervical dilation and effacement. At 37 weeks gestation with contractions every 10 minutes, assessing cervical dilation and effacement is crucial to determine if the patient is in active labor. This information will guide the nurse in determining the appropriate next steps for the patient's care, such as the need for further monitoring or interventions. Assessing vital signs and fetal heart rate (Choice A) is important but not the priority in this scenario. Urinary output and fluid balance (Choice C) are important considerations but not the immediate priority. Emotional status and support system (Choice D) are also important but not the first assessment to be made in this situation.

Correct Answer: D

Rationale: The correct answer is D because the nurse's priority action in this scenario is to report the rupture of membranes to the healthcare provider immediately. This is crucial to ensure timely assessment and management to prevent infection and monitor for potential complications. Checking fetal heart rate and vital signs (A) can be important but not as urgent as reporting the rupture of membranes. Encouraging the patient to go home and rest (B) is inappropriate as leaking clear fluid at 40 weeks gestation may indicate rupture of membranes. Instructing the patient to monitor fetal movement and call back (C) is not sufficient as immediate medical attention is needed in case of ruptured membranes.

Correct Answer: D

Rationale: The correct answer is D because attending all prenatal visits and following the doctor's advice is crucial for monitoring the health of both the mother and the baby. It ensures early detection of any potential issues and proper management throughout the pregnancy. This statement shows the patient's commitment to their prenatal care, which is essential for a healthy pregnancy outcome. Explanation for why other choices are incorrect: A: Avoiding exercise completely is not recommended during pregnancy, as moderate exercise is beneficial for both the mother and the baby. B: While staying hydrated and resting when tired are important, they do not solely indicate effective prenatal education. C: Eating for two is a common misconception; the focus should be on a balanced diet rather than overeating.

Correct Answer: D

Rationale: The correct answer is D: Teach the patient to rise slowly from a sitting or lying position. This response is appropriate because the patient is likely experiencing orthostatic hypotension, which is common during pregnancy due to hormonal changes. Rising slowly helps prevent sudden drops in blood pressure, reducing dizziness and fainting. A: Instructing the patient to avoid standing for long periods does not address the underlying issue of orthostatic hypotension. B: Encouraging increased sodium intake may not be necessary and could potentially have negative effects. C: Recommending frequent naps does not address the immediate problem of orthostatic hypotension when standing up quickly.

Correct Answer: B

Rationale: The correct answer is B: Monitor the patient's blood pressure regularly and check for protein in the urine. This is the most appropriate intervention because the patient has a history of hypertension, which can lead to complications like preeclampsia. Regular blood pressure monitoring and urine protein checks are essential in detecting early signs of preeclampsia, allowing for timely intervention to prevent complications. Choice A: Encouraging the patient to increase salt intake would worsen hypertension and increase the risk of complications. Choice C: Increasing physical activity and exercise may not be safe for a pregnant patient with hypertension and can potentially raise blood pressure. Choice D: Limiting fluid intake can lead to dehydration and is not recommended during pregnancy, especially with a history of hypertension.