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33 the nurse assesses the 34 week pregnant client

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33. The nurse assesses the 34-week pregnant client (G2Pl). Place theassessment findings in the sequence that they should be addressed by thenurse from the most significant to the least significant.A.Pedal edema at +3B.BP 144/94 mm HgC.Positive group beta streptococcus vaginal cultureD.Fundal height increase of 4.5 cm in 1 weekANSWER:B, D, A, CB. BP 144/94 mm Hg warrants immediate evaluation. It could indicate preeclampsia, a condition that canprogress to serious complications.D. Fundal height increase of 4.5 cm in 1 week is abnormal and requires further follow-up. Normal fundalheight increase is l to 2 cm per week. An increase in fundal size can be related to gestational diabetes,large-for-gestational—age fetus, fetal anomalies, or polyhydramnios.
A. Pedal edema at +3 may be a normal physiological process if it is an isolated finding. Pedal edemawarrants further assessment because it can be a symptom of preeclampsia.C. Positive group beta streptococcus vaginal culture warrants antibiotic treatment in labor but does notwarrant intervention during the pregnancy.34. The pregnant client tells the nurse that she thinks she is carrying twins. Inreviewing the client’s history and medical records, the nurse shoulddetermine that which factors are associated with a multiple gestation? Selectall that apply.
A.An elevated serum alpha-fetoprotein level (an oncofetal protein normally produced bythe fetal liver and yolk sac) is associated with a multiple gestation.B.The use of reproductive technology such as artificial insemination or fertility drugs isassociated with a multiple gestation.C.Maternal age greater than 40 is not associated with multiple gestation.D.History of twins in the family is associated with a multiple gestation.E.An elevated Hgb is not associated with multiple Gestation.

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Term
Fall
Professor
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Ectopic pregnancy

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