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A nurse is assessing a client who is 6 months pregnant.Which findings should the nurse expect? (Select all four options that apply.)

A.

hypoactive oil and sweat glands

B.

increased skin pigmentation

C.

Persistent migraine headaches

D.

Facial edema

E.

Melasma

F.

Linea nigra

Question Solution

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 C

Explanation

A. The patient's chart may provide historical information but does not reflect the current pain intensity the client is experiencing.

B. Visual observation for nonverbal signs of pain can be useful, especially for nonverbal patients, but self-reporting is the most accurate measure of pain intensity.

C. The client's self-report of pain severity is the gold standard for assessing pain intensity, as it reflects the individual’s personal experience of pain.

D. While the nature and invasiveness of the surgical procedure can provide context for expected pain levels, they do not replace the importance of the client's self-report in managing pain effectively.

Correct Answer is D

Explanation

A. Presbyopia refers to age-related difficulty in seeing close objects due to loss of elasticity in the lens, not distance vision.

B. Astigmatism is a condition caused by an irregular curvature of the eye, leading to blurred vision at any distance.

C. Hyperopia (farsightedness) is the inability to see close objects clearly, not distant ones.

D. Myopia (nearsightedness) is the condition where a person cannot see objects at a distance clearly, making it the correct term for this finding.

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