- A client at 8 weeks gestation calls the clinic and reports a small amount of bright red vaginal spotting. Which instruction should the PN give the client?
Answer: "You need to come to the clinic to be evaluated by the provider."
Any vaginal bleeding during early pregnancy must be evaluated by a healthcare provider to rule out potential complications such as a threatened miscarriage or ectopic pregnancy. The PN should instruct the client to come in for evaluation. Dismissing it as normal is unsafe, and while rest is good, it doesn't replace evaluation. An ED visit may not be necessary unless bleeding is heavy or accompanied by severe pain.
- A client at 9 weeks gestation tells the PN, "Some days I am so excited about being pregnant, but other days I feel scared and am not sure I'm ready." Which response by the PN is most therapeutic?
Answer: "Feeling uncertain and having mixed emotions is very common in the first trimester."
This response normalizes the client's experience of ambivalence, which is a common and expected emotional response during the first trimester of pregnancy. It validates her feelings and provides reassurance. The other options are dismissive, escalate the situation prematurely, or offer a negative interpretation.
- A client at 38 weeks gestation reports having contractions. The PN is collecting data to help determine if the client is in true labor. Which finding is most consistent with true labor?
Answer: Contractions become stronger, longer, and closer together.
The key characteristic of true labor is a progressive pattern of contractions that increase in frequency, duration, and intensity over time. Contractions that are irregular, stop with activity, or are felt only in the abdomen are typically signs of false labor (Braxton Hicks contractions). The PN collects this data to report to the RN.
- A client scheduled for a first-trimester transvaginal ultrasound asks the PN if she needs to do anything to prepare. What is the most accurate information for the PN to provide?
Answer: "You will be asked to empty your bladder right before the procedure."
For a transvaginal ultrasound, particularly in the first trimester, an empty bladder allows for better visualization of the pelvic organs as the probe is placed in the vagina, close to the uterus. A full bladder is required for a transabdominal ultrasound to help lift the uterus out of the pelvis. NPO status is not required.
- The PN is reinforcing teaching for a pregnant client who has been prescribed ferrous sulfate for anemia. Which statement indicates the client understands how to take this medication?
Answer: "I should take this medication on an empty stomach with orange juice."
Iron is best absorbed on an empty stomach, and absorption is enhanced by Vitamin C, which is found in orange juice. Milk and other dairy products contain calcium, which can inhibit iron absorption. Iron supplements typically cause stools to become dark green or black, not lighter. Coffee and tea can also decrease iron absorption.
- A client in her third trimester reports frequent heartburn. Which recommendation should the PN reinforce?
Answer: "Eat small, frequent meals throughout the day."
Eating small, frequent meals prevents the stomach from becoming overly full and reduces pressure on the cardiac sphincter, which helps to alleviate heartburn. Lying down after meals and eating spicy/fatty foods can exacerbate reflux and heartburn. While antacids may provide temporary relief, dietary modifications are the first-line recommendation.
- A practical nurse (PN) is reinforcing teaching about nutrition to a client at 10 weeks gestation. Which statement by the client indicates an understanding of the teaching?
Answer: "I need to increase my folic acid intake to prevent birth defects."
The correct statement indicates an understanding of the importance of folic acid in preventing neural tube defects in the developing fetus. Doubling caloric intake is a common misconception and can lead to excessive weight gain. Prenatal vitamins are necessary to supplement a balanced diet and ensure adequate micronutrient levels. Avoiding dairy is unnecessary unless the client has a lactose intolerance and could lead to inadequate calcium intake.
- The PN is reinforcing dietary teaching for a client with newly diagnosed gestational diabetes. Which statement by the client indicates an understanding of the dietary plan?
Answer: "I need to eat consistent amounts of carbohydrates at meals and snacks."
The cornerstone of dietary management for gestational diabetes is consistent carbohydrate intake, distributed throughout the day in meals and snacks, to maintain stable blood glucose levels. Avoiding all carbohydrates is unhealthy for both the client and fetus. Fruit contains carbohydrates and must be portioned. Weight loss is generally not recommended during pregnancy.
- A pregnant client expresses anxiety about her ability to care for a newborn. Which action by the PN demonstrates therapeutic communication?
Answer: "Tell me more about what is making you feel anxious."
Using an open-ended statement like "Tell me more…" is a therapeutic technique that encourages the client to verbalize her feelings and concerns. The other options are non-therapeutic: offering false reassurance (A, D) or giving unsolicited advice (C), which can block communication and invalidate the client's feelings.
- A client at 14 weeks gestation who runs 3 miles daily asks the PN if she can continue her exercise routine. Which response by the PN is most appropriate?
Answer: "You should discuss your specific exercise plan with the healthcare provider."
While exercise is generally encouraged, specific recommendations depend on the client's pre-pregnancy fitness level and the status of her current pregnancy. The PN's scope of practice is to encourage the client to consult with the primary healthcare provider for individualized clearance and guidance. The other options provide incorrect or overly restrictive advice.
- The PN is reinforcing instructions about monitoring fetal movement to a client at 30 weeks gestation. Which statement by the client indicates that further teaching is needed?
Answer: "If I notice a lot of movement, I should call the clinic immediately."
Further teaching is needed because a significant decrease or absence of fetal movement is the primary concern that needs to be reported, not an increase. Active fetal movement is a sign of well-being. The other statements reflect a correct understanding of how to perform and interpret fetal kick counts.
- A 32-week nonstress test is nonreactive after 40 minutes. What should the nurse prepare?
Answer: Biophysical profile
A nonreactive NST after 40 minutes means the fetus did not show the expected accelerations, so you need a more thorough assessment of fetal well-being. A biophysical profile combines the NST with ultrasound to evaluate fetal breathing, movement, tone, and amniotic fluid. The tempting wrong answer is repeating the NST in one week, because that delays the needed evaluation. Home fetal kick counts and immediate cesarean birth are not the next steps.
- A client in the first trimester of pregnancy reports frequent nausea and vomiting. Which suggestion should the PN offer to help manage this discomfort?
Answer: "Eat small, frequent meals and snacks throughout the day."
Eating small, frequent meals helps to keep the stomach from becoming too empty or too full, which can trigger nausea. Large, high-fat meals can worsen nausea and are hard to digest. Drinking large amounts of fluid with meals can increase stomach distention and nausea. Lying down after eating can worsen heartburn and does not aid in managing nausea.
- The PN observes a client at 36 weeks gestation lying flat on her back for an examination. The client states, "I feel dizzy and nauseous." What is the PN's priority action?
Answer: Assist the client to turn onto her left side.
The client is exhibiting symptoms of supine hypotensive syndrome, caused by the gravid uterus compressing the inferior vena cava and aorta, which reduces venous return and cardiac output. The immediate priority is to relieve the compression by displacing the uterus. Assisting the client to a left lateral position is the fastest and most effective intervention.
- A client at 20 weeks gestation reports dysuria and urinary frequency. Which action should the PN take first?
Answer: Obtain a clean-catch urine specimen for analysis.
While urinary frequency is normal, dysuria (painful urination) is a classic sign of a urinary tract infection (UTI). UTIs are common in pregnancy and can lead to serious complications like pyelonephritis and preterm labor if untreated. The priority action is to collect a urine specimen for diagnosis before any other intervention.
- A pregnant client is concerned about reddish-purple streaks that have appeared on her abdomen and breasts. The PN should identify these markings as which of the following?
Answer: Striae gravidarum
Striae gravidarum is the medical term for stretch marks, which are reddish-purple streaks resulting from the stretching of the skin and are common on the abdomen, breasts, and thighs during pregnancy. Chloasma is hyperpigmentation on the face. Linea nigra is the dark line on the abdomen. Vascular spiders are small, red vascular lesions.
- At 34 weeks, which symptom must be reported to the provider immediately?
Answer: Epigastric pain with blurring
Epigastric pain with visual blurring are red-flag signs of severe preeclampsia, which can progress to eclampsia or HELLP syndrome, so this must be reported immediately. Heartburn, evening ankle swelling, and painless irregular tightening are common discomforts at 34 weeks. The most tempting wrong choice is heartburn after chili, but that is reflux, not the epigastric pain of preeclampsia.
- A client at 30 weeks gestation asks the PN if she should get the Tdap vaccine. What is the most appropriate response by the PN?
Answer: "Yes, the Tdap vaccine is recommended for all pregnant women between 27 and 36 weeks."
The PN can reinforce current CDC guidelines, which recommend the Tdap (tetanus, diphtheria, acellular pertussis) vaccine during each pregnancy, ideally between 27 and 36 weeks gestation. This provides passive immunity to the newborn to protect against pertussis (whooping cough). The Tdap is an inactivated vaccine, not a live vaccine.
- A client at 26 weeks gestation is scheduled for a 1-hour glucose tolerance test. The PN is reinforcing instructions for the test. Which instruction is correct?
Answer: "You will be asked to drink a sweet liquid, and your blood will be drawn one hour later."
This correctly describes the procedure for the 1-hour glucose challenge test, which is a screening for gestational diabetes. Fasting is not required for the 1-hour screening test. Eating a high-carb meal just before could skew the results. The 3-hour glucose tolerance test (a diagnostic test) requires fasting and multiple blood draws.
- A client at 34 weeks gestation complains of frequent leg cramps at night. Which self-care measure should the PN suggest?
Answer: Dorsiflex the foot during the cramp.
To relieve a muscle cramp in the calf, the client should be instructed to dorsiflex the foot (pull the toes toward the head). This action stretches the calf muscle and alleviates the spasm. Pointing the toes (plantar flexion) can worsen the cramp. Caffeine can contribute to dehydration and cramps. Leg elevation helps with edema.
