A woman who is 36 weeks pregnant presents to the labor and delivery unit with a history of congestive heart disease. Which of the following findings should the nurse report to the primary health-care practitioner?
a. Presence of chloasma
b. Presence of severe heartburn
c. 10-pound weight gain in a month
d. Patellar reflexes +1
ANS: c
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a. Chloasma is a normal pregnancy finding.
b. Heartburn is an expected finding during the third trimester.
c. The weight gain may be due to fluid retention. Fluid retention may occur in patients with pregnancy-induced hypertension and in patients with congestive heart failure. The physician should be notified.
d. Although slightly hyporeflexic, patellar reflexes of +1 are within normal limits.
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