Which finding during a prenatal visit is most concerning in a client at 32 weeks gestation?

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Proteinuria of +2 on a urine dipstick, which is most concerning at 32 weeks gestation. Proteinuria can indicate a potential problem with the kidneys, specifically preeclampsia, a serious condition characterized by high blood pressure and protein in the urine. Preeclampsia can lead to complications for both the mother and the baby if not managed promptly. Option A, a blood pressure of 120/80 mmHg, falls within the normal range during pregnancy and is not typically a cause for concern. Option B, mild lower back pain, is common in pregnancy and may not signal a serious issue unless accompanied by other symptoms. Option C, a weight gain of 2 pounds in one week, can be normal in pregnancy as long as it is within recommended guidelines. Educationally, it is crucial for healthcare providers to recognize the significance of proteinuria in prenatal care as it can indicate a potentially life-threatening condition like preeclampsia. Regular monitoring of blood pressure, urine dipstick tests, and other prenatal assessments is essential to detect and manage complications early, ensuring the best possible outcomes for both the mother and the baby.

Correct Answer: B

Rationale: In the context of newborn hearing screening, the correct response for a nurse when a mother asks about it is option B) Reassure the mother that this is a routine test. This response is appropriate because newborn hearing screening is a standard procedure recommended for all infants shortly after birth. By reassuring the mother that this is routine, the nurse can alleviate any concerns or anxieties the mother may have regarding the test. Option A) Explain that hearing screening is optional is incorrect because newborn hearing screening is considered a crucial part of early identification of hearing loss and is recommended for all infants. Option C) Inform the mother that hearing screening is mandatory is not entirely accurate as parents usually have the right to decide whether to proceed with the screening, although it is highly recommended. Option D) Provide resources for further testing if needed is not the most suitable response initially as the focus should be on reassuring the mother about the routine nature of the screening test before discussing further steps if any issues are identified. In an educational context, it is essential for nurses to understand the significance of newborn hearing screening and be able to effectively communicate with parents about the procedure to ensure timely identification and intervention in case of hearing loss, emphasizing the importance of early detection in promoting optimal developmental outcomes for the newborn.

Correct Answer: D

Rationale: In the context of a laboring mother experiencing variable decelerations, the recommended position is D) Position the mother in a side-lying position. This position can help alleviate pressure on the mother's vena cava, improving blood flow to the placenta and reducing the likelihood of further decelerations. Option A) Positioning the mother in a supine position can compress the vena cava, reducing blood flow to the placenta and potentially worsening the decelerations. Option B) While encouraging the mother to change positions frequently can be beneficial in labor, in the case of variable decelerations, a specific position change to a side-lying position is more appropriate. Option C) Using a peanut ball to widen the pelvis is a helpful technique to promote optimal fetal positioning and progress in labor but may not directly address the issue of variable decelerations. Educationally, understanding the impact of maternal positioning on fetal well-being during labor is crucial for healthcare providers to effectively manage and optimize maternal and neonatal outcomes. The rationale behind the correct answer emphasizes the importance of individualized care based on the specific clinical situation to promote safe and effective labor management.

Correct Answer: A

Rationale: In caring for an immediate postpartum client, you should monitor closely for HELLP syndrome, which stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. HELLP syndrome is a serious complication of pregnancy characterized by high blood pressure, protein in the urine, and problems with the liver and blood-clotting system. It can lead to severe bleeding issues, organ failure, and other life-threatening complications if not promptly recognized and managed. Therefore, close monitoring for signs of HELLP syndrome is crucial in the postpartum period to ensure timely intervention and prevent adverse outcomes.

Correct Answer: B

Rationale: In incomplete abruptio placenta, the separation begins at the periphery of the placenta. This results in partial detachment of the placenta from the uterine wall, rather than almost total separation as seen in complete abruptio placenta. This type of abruptio placenta may present with vaginal bleeding depending on the extent of separation and may lead to various degrees of maternal and fetal compromise.