A nurse is answering Questions about labor and delivery to a client.The client is concerned that she will need a blood transfusion due to all the blood loss during the delivery.The nurse explains that blood volume increases during pregnancy that will offset the loss.Which of the following is the correct percentage of increased blood volume during pregnancy that the nurse should explain to the client?
25%-35%.
10%-20%.
60%-70%.
40%-50%.
The Correct Answer is D
Choice A rationale
A 25%-35% increase in blood volume is lower than the actual increase observed during pregnancy. This choice is incorrect.
Choice B rationale
A 10%-20% increase in blood volume is significantly lower than the actual increase observed during pregnancy. This choice is incorrect.
Choice C rationale
A 60%-70% increase in blood volume is higher than the actual increase observed during pregnancy. This choice is incorrect.
Choice D rationale
The correct percentage of increased blood volume during pregnancy is 40%-50%. This increase helps accommodate the growing fetus and placenta, and prepares the body for the blood loss that occurs during delivery.
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Correct Answer is ["A","C","D","E"]
Explanation
Choice A rationale
Nausea is a common symptom during pregnancy, especially in the first trimester. It is often referred to as morning sickness, although it can occur at any time of the day. The client’s report of nausea almost every day for the last two months, but lasting for a shorter period of the day, is consistent with typical pregnancy-related nausea.
Choice B rationale
Malodorous vaginal discharge is not a common or expected physiological change during pregnancy. It may indicate an infection or other medical condition that requires further evaluation and treatment.
Choice C rationale
Increased frequency of urination is a common symptom during pregnancy. It occurs due to hormonal changes and the growing uterus putting pressure on the bladder. The client’s report of voiding more frequently without pain is consistent with normal physiological changes during pregnancy.
Choice D rationale
Fundal height measurement is used to assess fetal growth and development. At 18 weeks of gestation, the fundal height is typically around 18 cm, which corresponds to the number of weeks of pregnancy. This finding is consistent with expected physiological changes during pregnancy.
Choice E rationale
The darkened line of skin noted midline on the abdomen, known as the linea nigra, is a common physiological change during pregnancy. It is caused by increased pigmentation and is a normal finding.
Choice F rationale
A dry, reddened patch of skin below the knee bilaterally is not a common or expected physiological change during pregnancy. It may indicate a dermatological condition or other medical issue that requires further evaluation.
Correct Answer is C
Explanation
Choice A rationale
Providing additional information about the disorder is appropriate as it helps the couple understand the condition better and prepare for the future. This information can include the nature of the disorder, potential complications, and available treatments or interventions.
Choice B rationale
Referring the couple to a disorder-specific support group is also appropriate. Support groups can provide emotional support, practical advice, and a sense of community for families facing similar challenges. This can help the couple cope with the diagnosis and connect with others who have similar experiences.
Choice C rationale
Determining whether termination has been considered is inappropriate because the couple has already decided to continue the pregnancy. Bringing up termination at this point can be distressing and may undermine their decision. The nurse should respect their choice and focus on providing support and information relevant to continuing the pregnancy.
Choice D rationale
Explaining that they may experience grief, which is normal, is appropriate. Grief is a common response to learning about a serious genetic disorder in a fetus, and normalizing these feelings can help the couple process their emotions and seek appropriate support.