101 obstetrical nursing notes question and rationale for your references.
- A 37-week-pregnant client calls the clinic to express her concern about shortness of breath and her inability to sleep unless she places three pillows under her head. Which action should the nurse take after listening to the client’s concerns?
a. Schedule an appointment to have the dent assessed.
b. Explain that these are common side effects of pregnancy in the later stages.
c. Make arrangements for the dent to be admitted to the birth facility and begin preparations for the birth.
d. Inform the client that she should go to the hospital since she is showing signs of heart failure.
Rationale: The nurse must differentiate between normal physiologic problems in late pregnancy and those that require referral to a health care practitioner. The client expresses natural physiologic changes as a result of the expanding uterus and strain on the diaphragm in this situation. These symptoms are not indicative of heart failure. The customer does not require medical attention or admission to the birth center.