A pregnant client asks the nurse in the clinic when she will be able to start feeling the fetus move. The nurse responds by telling the client that fetal movements will be noted between _____ weeks' gestation
1. 6 and 8
2. 8 and 10
3. 12 and 14
4. 16 and 20
4
Rationale: Fetal movement, called quickening, is not perceived until the second trimester. Be-tween 16 and 20 weeks' gestation, the expectant client first notices subtle fetal movements that gradually increase in intensity.
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When auscultating the anterior thorax of a pregnant woman, the nurse notices the presence of a murmur over the second, third, and fourth intercostal spaces. The murmur is continuous but can be obliterated by pressure with the stethoscope
or finger on the thorax just lateral to the murmur. The nurse interprets this finding to be: a. Murmur of aortic stenosis. b. Most likely a mammary souffle. c. Associated with aortic insufficiency. d. Indication of a patent ductus arteriosus.
A yellow crust has formed over the circumcision site. The mother calls the hotline at the local hospital 5 days after her son was circumcised. She is very concerned. On which ra-tionale should the nurse base her reply?
a. After circumcision, the diaper should be changed frequently and fastened snugly. b. This yellow crust is an early sign of infection. c. The yellow crust should not be removed. d. Discontinue the use of petroleum jelly to the tip of the penis.
Your patient has had hypertension for 10 years, a myocardial infarction 5 years ago, and now complains of dyspnea on exertion, cough, and 3-pillow orthopnea. Which of the following conditions is likely?
A. Right ventricular failure B. Pulmonary embolism C. Cor pulmonale D. Left ventricular failure
A nurse is caring for a frail older adult client with chronic obstructive pulmonary disease. The client always remains in a sitting position to help him breathe more easily
Based on the understanding that prolonged sitting may put pressure on bony prominences, the nurse frequently assesses which area of this client? A) Back of the skull B) Elbows C) Sacrum D) Heels