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Exam NCLEX-RN topic 6 question 18 discussion

Actual exam question from Test Prep's NCLEX-RN
Question #: 18
Topic #: 6
[All NCLEX-RN Questions]

A client is pleased about being pregnant, yet states, "It is really not the best time, but I guess it will be OK." The nurse’s assessment of this response is:

  • A. Initial maternal-infant bonding may be poor.
  • B. Client may have a poor relationship with her husband.
  • C. This response is normal in the first trimester.
  • D. This response is abnormal, to be re-evaluated at the next visit.
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Suggested Answer: C 🗳️
(A) Ambivalence is normal during the first trimester. Reva Rubin addresses the issue of "not now" in the first trimester. The statement still leaves room for exploration. (B) There are no data to support this. This statement by the mother still leaves room for exploration. (C) Ambivalenceis normal during the first trimester. Reva Rubin addresses the issue of "not now." This fact should be shared with the mother during further exploration of the comment. (D) It is not abnormal. If it were, another month would also be too long to wait.

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