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PN Daily #26 · Geriatrics / Aging · Archive

NCLEX-PN® question of the day

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The question

The LPN is assisting the RN in monitoring a client at 34 weeks gestation, G2P1, EDD in 6 weeks, admitted to the antepartum unit of a skilled nursing facility for observation after a fall. Baseline vital signs are T 98.6°F (37°C), HR 82, RR 18, BP 118/76. On this shift, the client's BP is 122/78, fetal heart rate is 140 bpm with moderate variability, fundal height measures 33 cm, and contractions are noted every 20 minutes, mild and irregular. The client reports a sudden gush of clear fluid from the vagina about 15 minutes ago. She asks the LPN if this is a normal part of pregnancy at this stage. Which action should the nurse take in response to the client's report?

  1. Continue routine monitoring and document the finding for the next scheduled assessment.
  2. Report the fluid leakage to the RN promptly while continuing to monitor fetal heart rate.
  3. Tell the client this is likely normal urinary leakage common in late pregnancy.
  4. Finish reinforcing the client's third-trimester nutrition teaching before addressing this report.

Today's and yesterday's questions are open to everyone. Older questions in the archive open with a free account, and the rationale for every option appears once you answer.