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Exam NCLEX-RN topic 4 question 92 discussion

Actual exam question from Test Prep's NCLEX-RN
Question #: 92
Topic #: 4
[All NCLEX-RN Questions]

A 17-year-old pregnant client who is gravida 1, para 0, is at 36 weeks gestation. Based on the nurses knowledge of the maternal physiological changes in pregnancy, which of these findings would be of concern?

  • A. Complaints of dyspnea
  • B. Edema of face and hands
  • C. Pulse of 65 bpm at 8 weeks, 73 bpm at 36 weeks
  • D. Hematocrit 39%
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Suggested Answer: B 🗳️
(A) Dyspnea is a common complaint during the third trimester owing to the increasing size of the uterus and the resulting pressure against the diaphragm. (B)
Edema of the face, hands, or pitting edema after 12 hours of bed rest may be indicative of preeclampsia and would be of great concern to the healthcare provider.
(C) An increase in heart rate of 1015 bpm is a normal physiological change in pregnancy due to the multiple hemodynamic changes. (D) A hematocrit value of
39% is within the normal range. A value <35% would indicate anemia.

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