A nurse is assessing a client who is 6 months pregnant.Which findings should the nurse expect? (Select all four options that apply.)
hypoactive oil and sweat glands
increased skin pigmentation
Persistent migraine headaches
Facial edema
Melasma
Linea nigra
Correct Answer : B,D,E,F
A. Hypoactive oil and sweat glands: Pregnancy typically causes increased activity in oil and sweat glands, not decreased.
B. Increased skin pigmentation: Increased pigmentation is common during pregnancy, often affecting areas like the areolas and abdomen.
C. Persistent migraine headaches: While some women may experience headaches in pregnancy, they are not an expected or typical finding and may require further assessment.
D. Facial edema: Mild facial edema can occur as pregnancy progresses, especially due to increased blood volume and fluid retention.
E. Melasma: Melasma, or "mask of pregnancy," is a common finding characterized by dark patches on the face due to hormonal changes.
F. Linea nigra: Linea nigra is a dark line that often appears on the abdomen during pregnancy as a result of hormonal changes.
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Correct Answer is B
Explanation
A. Observing for facial symmetry assesses cranial nerves VII (facial nerve), not cranial nerve III.
B. Cranial nerve III (oculomotor nerve) is responsible for eye movement and pupillary response, making checking the pupillary response to light the correct action.
C. Testing visual acuity primarily assesses cranial nerve II (optic nerve), not cranial nerve III.
D. Eliciting the gag reflex is associated with cranial nerves IX (glossopharyngeal) and X (vagus), not cranial nerve III.
Correct Answer is D
Explanation
A. A pustule is a small elevation of the skin that contains pus, typically smaller than 0.5 cm.
B. A macule is a flat, discolored area of skin that is less than 0.5 cm in diameter, so it does not fit the description of elevated lesions larger than 0.5 cm.
C. A papule is an elevated, solid lesion that is less than 0.5 cm in diameter; lesions larger than this would not be classified as papules.
D. A patch is defined as a flat, non-palpable lesion larger than 0.5 cm, and psoriasis can present as patches. Thus, the lesions described fit this classification.