Author Question: The nurse notes the following findings in a client at 12-weeks' gestation. Which of the findings ... (Read 41 times)

rlane42

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The nurse notes the following findings in a client at 12-weeks' gestation. Which of the findings would enable the nurse to tell the client that she is diagnostically pregnant?
 
  1. Fetal heart rate by Doppler
  2. Positive pregnancy test
  3. Positive Chadwicks sign
  4. Montgomery gland enlargement

Question 2

The nurse is caring for a laboring patient. A cervical exam indicates 8 cm dilation. The patient is restless, frequently changing position in an attempt to get comfortable. Which nursing action is most important?
 
  1. Leave the patient alone so she can rest.
  2. Ask the family to take a coffee-and-snack break.
  3. Encourage the patient to have an epidural for pain.
  4. Reassure the patient that she will not be left alone.



Jane

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Answer to Question 1

1
Explanation: 1. A fetal heart rate by Doppler is a diagnostic (positive) change of pregnancy.

Answer to Question 2

4
Rationale 1: The patient is in the transitional phase of the first stage of labor, and will not want to be alone.
Rationale 2: The patient is in the transitional phase of the first stage of labor. The family members might want to take a break, but the patient will not want to be alone.
Rationale 3: The patient is in the transitional phase of the first stage of labor. There is no indication that the patient wants pain relief.
Rationale 4: Because the patient is in the transitional phase of the first stage of labor, she will not want to be left alone; staying with the patient and reassuring her that she will not be alone are the highest priorities at this time.



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