Custom: NSG 135 Exam #3 Spring 2025

Explanation

C. "A gain of about 25 to 35 pounds is recommended for you."
For a client with a normal BMI (18.5–24.9) prior to pregnancy, the recommended weight gain during pregnancy is typically between 25 and 35 pounds. This range is appropriate for the majority of women who start pregnancy at a healthy weight. This weight gain supports both the growing fetus and the mother’s increased blood volume, uterine size, and amniotic fluid.

Why the Other Options Are Incorrect:

A. "A gain of about 1 pound per week is recommended for you."
While 1 pound per week is a reasonable guideline for weight gain during the second and third trimesters, the total recommended weight gain over the course of pregnancy should be 25 to 35 pounds, not just a specific weekly gain. This answer doesn't provide the appropriate range for the entire pregnancy.

B. "A gain of about 15 to 25 pounds is recommended for you."
This recommendation is more applicable to overweight women or those who are slightly underweight before pregnancy. For a normal-weight woman, 25 to 35 pounds is typically the more accurate recommendation, as it accounts for the various physiological changes during pregnancy.

D. "A gain of about 30 to 40 pounds is recommended for you."
This weight gain range is typically recommended for underweight women or those carrying twins or multiple fetuses. For a normal-weight woman, this would be excessive and could increase the risk of complications like gestational diabetes or hypertension.

Summary:

The correct answer is C. "A gain of about 25 to 35 pounds is recommended for you." This is the general recommendation for a normal-weight woman during pregnancy, and it supports both maternal and fetal health. The other answers either underestimate or overestimate the appropriate weight gain for this client.

Explanation

Correct answer: A. "This medication promotes softening of the cervix."

Explanation:

• A. "This medication promotes softening of the cervix":
  
  • Dinoprostone gel is a prostaglandin used to ripen the cervix in preparation for labor. It helps in softening, dilating, and effacing the cervix to facilitate labor. This is the correct purpose of dinoprostone in prenatal care.
    

Why the other options are incorrect:

• B. "This medication is used to treat preeclampsia":
  
  • Dinoprostone is not used to treat preeclampsia. Preeclampsia is typically managed with antihypertensive medications, magnesium sulfate, and possibly delivery. Dinoprostone is used for cervical ripening and induction of labor, not for preeclampsia.
    
• C. "It causes relaxation of the uterine muscles":
  
  • Dinoprostone does not primarily cause relaxation of the uterine muscles. It is used to promote cervical ripening and initiate labor, but it does not relax the uterine muscles. Medications like tocolytics (e.g., terbutaline) are used to relax the uterine muscles in preterm labor.
    
• D. "It is used to treat genital herpes simplex virus":
  
  • Dinoprostone is not used to treat genital herpes simplex virus. The treatment for genital herpes typically involves antiviral medications (e.g., acyclovir), not cervical ripening agents like dinoprostone.
    

Correct Answer Is:

Dinoprostone gel is used to soften the cervix and promote cervical changes to help initiate labor. It does not treat preeclampsia, herpes, or cause uterine muscle relaxation.

Explanation

The correct answer is:

C. "It occurs during the first trimester and near the end of the pregnancy."

Explanation for the correct answer:

• Urinary frequency is a common symptom during pregnancy due to hormonal changes and the growing uterus. It typically occurs in the first trimester due to the hormonal effects of pregnancy that increase blood flow to the kidneys, leading to increased urine production. As the pregnancy progresses, urinary frequency can return in the third trimester when the growing uterus exerts pressure on the bladder. Therefore, it is accurate to explain that urinary frequency can occur both early and late in pregnancy.
  

Why the other options are incorrect:

• A. "There is no way to predict how long it will last in each individual client."
  
  • While there can be some variability between individuals, it is generally predictable that urinary frequency will occur in the first and third trimesters. Saying there is "no way to predict" may cause unnecessary concern and confusion for the client.
    
• B. "In most cases it only lasts until the 12th week, but it will continue if you have poor bladder tone."
  
  • This is inaccurate because urinary frequency typically resolves or decreases after the first trimester, but it often reappears later in pregnancy due to the pressure of the growing uterus, not just due to bladder tone.
    
• D. "It's a minor inconvenience, which you should ignore."
  
  • While urinary frequency may be bothersome, it is important for the nurse to provide accurate information and reassurance, rather than minimizing the client's experience. Advising the client to "ignore" it can make the client feel unheard or dismissed.
    

Correct Answer Is:

Urinary frequency is common in the first and third trimesters of pregnancy. The nurse should reassure the client that it is a normal symptom due to hormonal changes and uterine pressure, and it typically resolves or decreases between these times.

Explanation

The correct answer is:

C. Access to prenatal care

Explanation for the correct answer:

• Access to prenatal care is the most significant factor influencing maternal health outcomes in the United States. Regular prenatal care helps identify and manage complications early in pregnancy, provides essential screenings and tests, and promotes healthy behaviors and lifestyle changes. Lack of access to prenatal care increases the risk of complications such as preterm labor, preeclampsia, gestational diabetes, and poor fetal outcomes. It is essential to ensure that pregnant women have access to the necessary medical care to ensure the health of both the mother and the baby.
  

Why the other options are incorrect:

• A. Occupation
  
  • While occupation can impact health, especially in cases where the job exposes the individual to harmful substances or physical stress, it does not have as significant an impact on maternal health outcomes as access to prenatal care.
    
• B. Level of education
  
  • Education level can influence health outcomes, but it is less directly impactful compared to access to prenatal care. Education often affects health literacy and decision-making, but prenatal care is a more direct intervention for improving maternal health.
    
• D. Marital status
  
  • Marital status may affect maternal health outcomes in some ways (e.g., emotional support), but it is not as directly influential as having access to prenatal care. Many other factors, such as socioeconomic status and access to healthcare, play a larger role in maternal health.
    

Correct Answer Is:

Access to prenatal care is the most significant factor influencing maternal health outcomes in the United States, as it directly impacts the ability to monitor and address health issues during pregnancy. While other factors like occupation, education, and marital status can influence health, they do not have as profound an effect on maternal health outcomes as prenatal care.

Explanation

Explanation for the correct answer:
Preeclampsia is a pregnancy complication characterized by elevated blood pressure and signs of organ dysfunction, including proteinuria, edema, and neuromuscular irritability. One hallmark of worsening preeclampsia is hyperreflexia, or increased deep tendon reflexes (DTRs) due to central nervous system irritability. A DTR of +1 is diminished, not exaggerated, and is therefore inconsistent with the typical findings in preeclampsia. In fact, as preeclampsia progresses, patients are more likely to have +3 or +4 DTRs, which may precede seizures.

Why the other options are incorrect:

A. 1+ pitting sacral edema
This is a common finding in preeclampsia, especially in late pregnancy. Although edema alone is not diagnostic, it frequently occurs in conjunction with other signs like hypertension and proteinuria.

B. 3+ protein in the urine
Proteinuria of ≥300 mg in 24 hours or ≥1+ on a dipstick is a diagnostic criterion for preeclampsia. A reading of 3+ is consistent with moderate to severe proteinuria and supports the diagnosis.

C. Blood pressure 148/98 mm Hg
Hypertension in preeclampsia is defined as a systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg on two occasions at least 4 hours apart. A BP of 148/98 mm Hg clearly meets this criterion and is consistent with preeclampsia.

Summary:

The correct answer is D. Deep tendon reflexes of +1, which is inconsistent with preeclampsia. Clients with preeclampsia often exhibit hyperreflexia (+3 or higher) due to central nervous system irritability. In contrast, diminished reflexes may indicate other issues, such as magnesium sulfate toxicity (if being treated). The other findings—edema, proteinuria, and elevated blood pressure—are typical manifestations of preeclampsia.

Explanation

C. "I should increase my calcium intake to 1,500 milligrams per day."
The recommended daily intake of calcium during pregnancy is typically 1,000 milligrams for women aged 19-50. For women under 19 years old, the recommendation increases to 1,300 milligrams per day. 1,500 milligrams per day is above the usual recommended amount and would require clarification. The nurse should educate the client that calcium intake should align with the standard recommendations to avoid potential overconsumption.

Why the Other Options Are Correct:

A. "I should drink about 2 liters of fluid each day."
Adequate hydration is essential during pregnancy, and drinking about 2 liters (or 8 cups) of fluid daily is generally a good guideline. Pregnant women need extra fluids due to the increased blood volume and other physiological changes. This statement does not require clarification.

B. "I should not drink alcoholic beverages during my pregnancy."
This statement is correct. Alcohol consumption during pregnancy can cause fetal alcohol spectrum disorders (FASDs), which can lead to long-term physical, behavioral, and intellectual disabilities in the child. It is strongly advised to avoid alcohol during pregnancy.

D. "I can have a moderate amount of caffeine daily."
This statement is also correct. Moderate caffeine intake (up to 200 milligrams per day) during pregnancy is generally considered safe. This amount is equivalent to about one 12-ounce cup of coffee. Higher levels of caffeine can increase the risk of miscarriage, low birth weight, and preterm birth, so it's important to keep intake within the recommended limits.

Summary:

The correct answer is C. "I should increase my calcium intake to 1,500 milligrams per day." The client’s statement about calcium intake exceeds the typical recommendation. The other statements are consistent with standard prenatal advice regarding hydration, alcohol consumption, and caffeine intake.

Explanation

The correct answer is:

D. Persistent vomiting that prevents fluid intake

Explanation for the correct answer:

• Persistent vomiting that prevents fluid intake is a warning sign that can indicate hyperemesis gravidarum, a condition that may cause dehydration, electrolyte imbalance, and weight loss. It is a more severe form of nausea and vomiting during pregnancy and requires medical attention to prevent complications for both the mother and fetus.
  

Why the other options are incorrect:

• A. Increased urination, especially at night
  
  • Increased urination, especially at night, is a common and normal symptom in pregnancy, particularly in the first trimester. It is typically due to hormonal changes and increased blood flow to the kidneys. It does not require calling the clinic unless it is associated with other symptoms like pain or burning.
    
• B. Occasional mild headaches relieved with rest
  
  • Mild headaches are common in the first trimester due to hormonal changes, increased blood volume, and changes in blood pressure. If headaches are mild and relieved by rest, they are not typically a cause for concern. However, persistent or severe headaches may require further evaluation.
    
• C. Breast tenderness and enlargement
  
  • Breast tenderness and enlargement are normal symptoms in the first trimester due to hormonal changes in pregnancy. These symptoms are generally not alarming and are part of the physiological changes the body undergoes in preparation for lactation.
    

Correct Answer Is:

Persistent vomiting that prevents fluid intake is a serious concern and could indicate hyperemesis gravidarum, which requires medical intervention. The other symptoms listed, while uncomfortable, are typically normal in the first trimester and do not warrant immediate concern.

Explanation

Correct answer:

D. G3 T1 P0 A1 L1

Here's the explanation:

• G3: The client has been pregnant 3 times: 1 abortion, 1 full-term birth, and the current pregnancy.
  
• T1: The client had 1 full-term pregnancy at 39 weeks.
  
• P0: The client has had 0 preterm births.
  
• A1: The client had 1 abortion (elective abortion at 9 weeks).
  
• L1: The client has 1 living child.
  

Why the other options are incorrect:

A. G3 T0 P2 A1 L1

• This option would imply that the client has had 2 preterm births and 0 full-term births, which is incorrect because the client had 1 full-term birth.
  

B. G2 T1 P0 A1 L2

• This suggests only 2 pregnancies, but the client has had 3 (including the abortion and full-term birth). Also, this option incorrectly suggests 2 living children, but the client has only 1 living child.
  

C. G3 T1 P0 A1 L2

• This option is also incorrect because it suggests 2 living children, but the client has only 1.
  

Correct Answer Is:

D. G3 T1 P0 A1 L1 is the correct answer. The client has had 3 pregnancies, 1 full-term birth, 1 abortion, and 1 living child.

Explanation

The correct answer is:

A. Tardive dyskinesia

Explanation for the correct answer:

• Tardive dyskinesia (TD) is a potentially irreversible movement disorder caused by long-term use of antipsychotic medications, such as chlorpromazine. It is characterized by involuntary movements, often involving the tongue, face, lips, and jaw. Symptoms may include lip smacking, tongue protrusion, grimacing, and rapid eye movements. This condition is most commonly seen after prolonged use of antipsychotics and can be very distressing for the patient.
  

Why the other options are incorrect:

• B. Parkinsonism:
  
  • Parkinsonism refers to symptoms similar to Parkinson's disease, such as tremors, rigidity, and bradykinesia (slowness of movement). While Parkinsonism can occur as a side effect of antipsychotics, it typically involves muscle rigidity and tremors, rather than the involuntary movements of the tongue and face seen in tardive dyskinesia.
    
• C. Dystonia:
  
  • Dystonia refers to muscle spasms or abnormal postures that can occur suddenly and be very painful. It is another potential side effect of antipsychotic medications but typically affects the neck, back, and extremities, not the tongue and face in the way seen with tardive dyskinesia.
    
• D. Akathisia:
  
  • Akathisia is characterized by a feeling of restlessness and the urge to move, often leading to an inability to sit still. It involves motor restlessness, not involuntary movements of the tongue and face. Patients may fidget or pace, but it does not involve the same type of abnormal, rhythmic movements seen in tardive dyskinesia.
    

Correct Answer Is:

The involuntary movements of the tongue and face are characteristic of tardive dyskinesia, an adverse effect of long-term antipsychotic use such as chlorpromazine.