{"id":141958,"date":"2024-09-21T10:01:43","date_gmt":"2024-09-21T10:01:43","guid":{"rendered":"https:\/\/learnexams.com\/blog\/?p=141958"},"modified":"2024-09-21T10:01:45","modified_gmt":"2024-09-21T10:01:45","slug":"the-nurse-is-caring-for-a-client-who-is-10-weeks-gestation-and-palpates-the-fundus-at-2-fingerbreadths-above-the-pubic-symphysis","status":"publish","type":"post","link":"https:\/\/www.learnexams.com\/blog\/2024\/09\/21\/the-nurse-is-caring-for-a-client-who-is-10-weeks-gestation-and-palpates-the-fundus-at-2-fingerbreadths-above-the-pubic-symphysis\/","title":{"rendered":"The nurse is caring for a client who is 10-weeks gestation and palpates the fundus at 2 fingerbreadths above the pubic symphysis."},"content":{"rendered":"\n

The nurse is caring for a client who is 10-weeks gestation and palpates the fundus at 2 fingerbreadths above the pubic symphysis.
The client reports nausea, vomiting, and scant dark brown vaginal discharge. Which action should the nurse take?
A.
Measure vital signs.<\/p>\n\n\n\n

B.
Obtain human chorionic gonadotropin levels.<\/p>\n\n\n\n

C.
Collect urine sample for urinalysis.<\/p>\n\n\n\n

D.
Recommend bed rest.<\/p>\n\n\n\n

The Correct answer and Explanation is:<\/mark><\/strong><\/p>\n\n\n\n

The correct answer is A. Measure vital signs.<\/strong><\/p>\n\n\n\n

Explanation<\/h3>\n\n\n\n

In the scenario provided, the client is at 10 weeks of gestation and presents with specific symptoms: nausea, vomiting, and scant dark brown vaginal discharge. The palpation of the fundus at 2 fingerbreadths above the pubic symphysis is consistent with expected findings at this stage of pregnancy. However, the combination of nausea, vomiting, and dark brown vaginal discharge raises concerns about potential complications.<\/p>\n\n\n\n

    \n
  1. Assessing Vital Signs<\/strong>: The first priority in any nursing assessment is to evaluate the client\u2019s vital signs, which include temperature, pulse, respiration, and blood pressure. These measurements help assess the client\u2019s overall stability and can provide early indications of complications, such as hemorrhage or infection. In early pregnancy, symptoms like dark brown discharge could indicate a threatened miscarriage or ectopic pregnancy, both of which necessitate immediate assessment for hemodynamic stability.<\/li>\n\n\n\n
  2. Potential Implications<\/strong>: Nausea and vomiting can be common in early pregnancy due to hormonal changes, but if these symptoms are severe (a condition known as hyperemesis gravidarum), they can lead to dehydration, electrolyte imbalances, and even potential harm to both the mother and fetus. The dark brown discharge may suggest old blood, but the presence of any discharge should be taken seriously, warranting further investigation.<\/li>\n\n\n\n
  3. Other Options<\/strong>: While obtaining human chorionic gonadotropin (hCG) levels (option B) can be useful in assessing pregnancy status or potential complications, it is secondary to immediate vital sign assessment. A urinalysis (option C) may also be helpful, but it does not address the immediate need to monitor the client\u2019s stability. Bed rest (option D) might be recommended based on the situation, but only after assessing the client\u2019s vital signs to determine the appropriate course of action.<\/li>\n<\/ol>\n\n\n\n

    In conclusion, measuring vital signs is the most critical and immediate action to ensure the safety and well-being of the client in this scenario.<\/p>\n","protected":false},"excerpt":{"rendered":"

    The nurse is caring for a client who is 10-weeks gestation and palpates the fundus at 2 fingerbreadths above the pubic symphysis.The client reports nausea, vomiting, and scant dark brown vaginal discharge. Which action should the nurse take?A.Measure vital signs. B.Obtain human chorionic gonadotropin levels. C.Collect urine sample for urinalysis. D.Recommend bed rest. The Correct […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-141958","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/141958","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=141958"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/141958\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=141958"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=141958"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=141958"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}