OB: AQ Wrap Up
The nurse is assessing a client with a tentative diagnosis of hydatidiform mole. Which clinical finding should the nurse anticipate? A) Hypotension B) Decreased fetal heart rate C) Unusual uterine enlargement D) Painless, heavy vaginal bleeding
C) Unusual uterine enlargement The proliferation of trophoblastic tissue filled with fluid causes the uterus to enlarge more quickly than if a fetus were in the uterus. Hypertension, not hypotension, often occurs with a molar pregnancy. There is no fetus within a hydatidiform mole. There may be slight painless vaginal bleeding.
What is the priority nursing intervention during the admission of a primigravida in labor? A) Monitoring the fetal heart rate B) Asking the client when she ate last C) Obtaining the client's health history D) Determining whether the membranes have ruptured
A) Monitoring the fetal heart rate Determining fetal well-being supersedes all other measures; if the fetal heart rate is absent or persistently decelerating, immediate intervention is required. The health history, including the client's last meal and whether the membranes have ruptured, may be taken once fetal well-being has been established.
A client in the birthing suite has spontaneous rupture of the membranes, after which a prolapsed cord is identified. The nurse calls for help and with a sterile gloved hand moves the fetal head off the cord. What should the nurse anticipate? A) Cesarean birth B) Prolonged labor C) Rapidly induced labor D) Vacuum extraction vaginal birth
A) Cesarean birth Immediate birth is necessary to prevent fetal hypoxia and death. Allowing a prolonged labor, inducing labor, or using vacuum extraction in a vaginal birth will increase pressure on the cord, resulting in fetal hypoxia.
A client who had a cesarean birth is unable to void 3 hours after the removal of an indwelling catheter. How would the nurse evaluate the client for bladder distension? A) By catheterizing the client for residual urine B) By palpating the client's suprapubic area gently C) By asking the client whether she still feels the urge to urinate D) By determining whether the client is experiencing suprapubic pain
B) By palpating the client's suprapubic area gently Palpation will indicate whether bladder distention is present. The increased intra-abdominal space available after birth can result in bladder distention without discomfort. Assessment should be done before interventions. Trauma to the area makes surrounding organs atonic; the client may have a full bladder and not feel the urge to void. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively.
A client calls the nurse-midwife in the prenatal clinic, complaining of sharp shooting pains in her lower abdomen and vaginal spotting. She is met at the emergency department of the hospital, where a diagnosis of ruptured tubal pregnancy is made. At what stage of the pregnancy does the nurse suspect the initial symptoms began? A) At 16 weeks' gestation B) Immediately after implantation C) About 6 weeks into the pregnancy D) Toward the end of the second trimester
C) About 6 weeks into the pregnancy About 6 weeks into the pregnancy, the fallopian tube is unable to expand to the size of the growing products of conception. Tubal pregnancies are unable to advance to 16 weeks because of the tube's inability to expand with the growing products of conception. The size of the fertilized egg immediately after implantation is minuscule and will cause no problem. Tubal pregnancies are unable to advance to the end of the second trimester because of the tube's inability to expand with the growing products of conception.
An expectant couple asks the nurse about the cause of low back pain in labor. The nurse replies that this pain occurs most often when the fetus is in what position? A) Breech B) Transverse C) Occiput anterior D) Occiput posterior
D) Occiput posterior A persistent occiput posterior position causes intense back pain because of fetal compression of the maternal sacral nerves. The breech position is not associated with back pain. The transverse position does not usually cause back pain. Occiput anterior is the most common fetal position and does not cause back pain.
At 37 weeks' gestation a client's membranes spontaneously rupture; however, she does not have any labor contractions. What action is most important in the nursing plan of care for this client? A) Monitoring for the presence of fever B) Monitoring for signs of preeclampsia C) Monitoring for heavy vaginal bleeding D) Making preparations for fetal scalp pH sampling
A) Monitoring for the presence of fever The possibility of an ascending infection increases when membranes have ruptured and birth is not imminent; the client must be monitored for signs of infection. Preeclampsia is unrelated to spontaneous rupture of the membranes. Heavy vaginal bleeding is a sign of placenta previa, which is generally diagnosed before membranes rupture. Fetal scalp pH sampling is not indicated with spontaneous rupture of membranes; it is indicated if persistent late decelerations are noted on the fetal monitor during labor.
Which nursing intervention is specific to clients in active labor who present with a history of cardiac disease? A) Encouraging frequent voiding B) Checking the blood pressure hourly C) Auscultating the lungs for crackles every 30 minutes D) Helping turn the client from side to side at 15-minute intervals
C) Auscultating the lungs for crackles every 30 minutes Clients with cardiac problems are prone to heart failure during active labor; crackles indicate the presence of pulmonary edema. Encouraging frequent voiding and checking the blood pressure hourly is done for all clients who are in labor. Helping turn the client from side to side at 15-minute intervals is not necessary; although clients who are in labor are maintained on the side to facilitate venous return, the sides do not have to be alternated every 15 minutes.
After a difficult labor a client gives birth to a 9-lb (4 kg) boy who expires shortly afterward. That evening the client tearfully describes to the nurse her projected image of her son and what his future might have been. What is the nurse's most therapeutic response? A) "I guess you wanted a son very much." B) "It must be difficult to think of him now." C) "I'm sure he would have been a wonderful child." D) "If you dwell on this now, your grief will be harder to bear."
B) "It must be difficult to think of him now." Stating that it must be difficult to think of him now demonstrates empathy; the nurse is attempting to show understanding of the client's feelings. Stating that the patient must have wanted a son very much is nontherapeutic; the nurse has no way of knowing this. Stating the certainty that the infant would have been a wonderful child switches the focus away from the client, whose needs should be met at this time. Stating that dwelling on the death will make her grief harder to bear denies the client's feelings and implies that the client should curb painful emotions.
A client with a suspected placenta previa is to have a repeat sonogram at 16 weeks' gestation. Which nursing intervention is necessary to prepare for this procedure? A) Inserting an indwelling urinary catheter B) Cleansing the abdomen with germicidal soap C) Ensuring that the client drinks two 8-oz (237 mL) glasses of water D) Administering a cleansing enema of 500 mL of normal saline
C) Ensuring that the client drinks two 8-oz (237 mL) glasses of water A full bladder helps stabilize the uterus during sonography, allowing better visualization of the fetus. Two full glasses of water, ingested 1 hour before the test, will fill the bladder. Emptying the bladder is inadvisable, because a full bladder supports the uterus and improves visualization. Because the procedure is noninvasive, it is unnecessary to cleanse the skin. An enema is contraindicated when placenta previa is suspected and will not improve visualization of the uterus anyway.
A client is admitted with a diagnosis of preeclampsia. Which significant clinical finding does the nurse expect when reviewing the client's history? A) Proteinuria B) Tachycardia C) Increased serum glucose D) Tonic-clonic movements
A) Proteinuria A characteristic of preeclampsia is vasospasms that cause renal injury, resulting in loss of protein in the urine. The maternal heart rate is not affected by preeclampsia. An increased serum glucose level is associated with uncontrolled diabetes, not preeclampsia. There are no data to indicate that the client had or is having a seizure. The admitting diagnosis is preeclampsia, not eclampsia. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.
A primigravida is admitted to the emergency department with a sharp, shooting pain in the lower abdomen and vaginal spotting. A ruptured tubal pregnancy is diagnosed. During what week of gestation does this condition most commonly occur? A) Sixth B) Twelfth C) Sixteenth D) Eighteenth
A) Sixth In the sixth week the fallopian tube can no longer expand to accommodate the size of the growing embryo. A tubal pregnancy cannot advance to the twelfth, sixteenth, or eighteenth week, because the tube cannot expand to accommodate the growing fetus. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.
A client is admitted to the birthing unit with uterine tenderness and minimal dark-red vaginal bleeding. She has a marginal abruptio placentae. The priority assessment includes fetal status, vital signs, skin color, and urine output. What additional assessment is essential? A) Fundal height B) Obstetric history C) Time of the last meal D) Family history of bleeding disorders
A) Fundal height It is vital that a baseline measurement be obtained, because increasing fundal height may be a sign of concealed hemorrhage. Taking an obstetric history, ascertaining the time of the last meal, and asking about a family history of bleeding disorders are all appropriate assessments; however, none are a priority at this critical time. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.
The nurse is caring for a pregnant client with type 1 diabetes. Which complication is the result of type 1 diabetes? A) Increased risk of hypertensive states B) Abnormal placental implantation C) Excessive weight gain because of increased appetite D) Decreased amount of amniotic fluid as the pregnancy progresses
A) Increased risk of hypertensive states The likelihood of gestational hypertension increases fourfold in the client with diabetes mellitus, probably because of a preexisting vascular disorder. Abnormal implantation occurs because of scarring or uterine abnormalities, not because of diabetes. Most pregnant women have an increased appetite; excessive weight gain may be caused by a macrosomic fetus and hydramnios. More than 2000 mL of amniotic fluid (hydramnios, polyhydramnios) is associated with diabetes; its exact cause is unknown. It also occurs with major congenital fetal anomalies, Rh sensitization, and infections (e.g., syphilis, toxoplasmosis, cytomegalovirus, herpes, and rubella). Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur.
A 26-year-old primigravida experiencing severe abdominal pain is brought to the emergency department by ambulance with a suspected ruptured tubal pregnancy. What should the nurse's initial action be? A) Insert an intravenous (IV) catheter. B) Ask the client to sign a surgical consent form. C) Determine whether a family member is present. D) Ascertain the first day of the client's last menstrual period.
A) Insert an intravenous (IV) catheter. The client is at risk for hypovolemic shock resulting from hemorrhage; administration of IV fluids is the priority. Asking the client to sign a surgical consent form, determining whether a family member is present, or ascertaining the first day of the client's last menstrual period is not the priority in an emergency situation.
The nurse is caring for a patient who has just had an amniotomy performed by the primary healthcare provider. The fetal heart rate immediately decreases from 140 to 80 beats/min. What is the priority nursing action? A) Inspecting the vagina B) Administering oxygen C) Increasing the intravenous fluids D) Placing the client in the knee-chest position
A) Inspecting the vagina Follow the nursing process and begin with an assessment to determine possible cause for the deceleration. This is likely to be a prolapsed cord based on the recent history of an amniotomy. Inspection of the vagina is performed. A cord prolapse requires immediate removal of the presenting part from the cord. Oxygen may be administered later; however, this is not the priority. Increasing the intravenous fluids is also not the priority at this time. Placing the client in the knee-chest position is an intervention that can be implemented once it is determined that the umbilical cord is prolapsed. This position relieves pressure on the cord, which increases the flow of oxygen and nutrients to the fetus.
A client at 26 weeks' gestation arrives at the clinic for her scheduled examination. Her blood pressure is 150/86 mm Hg. She tells the nurse that she has gained 5 lb (2.3 kg) in the last 2 weeks. What is the priority nursing action? A) Testing the client's urine for albumin B) Taking the client's body temperature C) Preparing the client for a vaginal examination D) Scheduling the client for an appointment in a week
A) Testing the client's urine for albumin Protein in the urine is an indication of preeclampsia, as are increased blood pressure and weight gain of more than 2 lb (0.9 kg) per week. Changes in body temperature are not associated with preeclampsia. These signs indicate preeclampsia; treatment does not require a vaginal examination. Scheduling the client for an appointment in a week is premature. More data must be collected and documented first.
The nurse notifies the primary healthcare provider that a client has been admitted to the high-risk unit in her thirty-sixth week of gestation. She is bleeding, has severe abdominal pain and a rigid fundus, and is demonstrating signs of impending shock. Which intervention should the nurse prepare for? A) A high-forceps birth B) An immediate cesarean birth C) Insertion of an internal fetal monitor D) Administration of an oxytocin infusion
B) An immediate cesarean birth An immediate cesarean birth is the ideal treatment for complete placental separation (abruptio placentae). The risk for fetal and maternal mortality is too high to delay action. High-forceps birth is rarely used, because the forceps may further complicate the situation by tearing the cervix. The fetus would probably expire if oxytocin were administered. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency.
The nurse applies fetal and uterine monitors to the abdomen of a client in active labor. When the client has contractions, the nurse notes a 15 beats/min deceleration of the fetal heart rate below the baseline lasting 15 seconds. What is the next nursing action? A) Calling the primary healthcare provider B) Changing the maternal position C) Obtaining the maternal blood pressure D) Preparing the environment for an immediate birth
B) Changing the maternal position The fetus is responding to partial cord compression. Stimulation of the fetal sympathetic nervous system is evidenced by the fetal heart rate deceleration. It is an initial response to mild hypoxia that accompanies partial cord compression during contractions; changing the maternal position can alleviate the compression. This is a compensatory physiologic response by a healthy fetus; the nurse, not the practitioner, should intervene by alleviating cord compression. Taking the client's blood pressure delays nursing interventions to help the fetus. Variable decelerations are not indicative of the need for an immediate birth.
The nurse in the prenatal clinic is caring for a pregnant client with well-controlled type 1 diabetes. Which outcome or modality does the nurse anticipate for this client? A) Cesarean birth B) Intensive prenatal care C) High perinatal mortality D) Decreased insulin requirements
B) Intensive prenatal care There is a constant need for evaluation of diabetic status, fetal maturity, and placental function; if the pregnancy is well managed, the outcome should be the same as for a healthy pregnancy. A client with well-controlled diabetes should be able to have a vaginal birth. If the diabetes is well controlled, the risk of perinatal mortality is the same as in the rest of the pregnant population. Insulin requirements vary and usually are increased during the second and third trimesters of pregnancy.
A client's membranes rupture during labor. The nurse immediately assesses the electronic fetal heart rate. Variable decelerations lasting more than 90 seconds, followed by bradycardia, are observed on the monitoring strip. Which physiologic finding does the nurse suspect is the cause of this abrupt change? A) Fetal acidosis B) Prolapsed cord C) Head compression D) Uteroplacental insufficiency
B) Prolapsed cord This variable pattern with bradycardia is an ominous sign; it is indicative of a prolapsed cord, or cord compression, which can result in fetal hypoxia. Immediate intervention is required. Fetal acidosis, not fetal heart rate changes, occurs with uteroplacental insufficiency. Early decelerations are associated with head compression and are benign. Late decelerations and tachycardia, not variable decelerations followed by bradycardia, are associated with uteroplacental insufficiency. Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action.
A client at 37 weeks' gestation is brought to the emergency department because of sudden abdominal pain. Abruptio placentae is suspected, and the client is transferred to the birthing unit. What should the nurse assess the client for? A) Bright-red vaginal bleeding and multiple clots B) Uterine tenderness and increased fetal activity C) Cessation of contractions and decreased uterine size D) Concealed hemorrhage and fetal heart rate accelerations
B) Uterine tenderness and increased fetal activity When the placenta initially separates, the fetus may become hyperactive as a response to acute hypoxia; the uterus is tender because of the accumulation of blood at the abrupted placental site. If bleeding occurs, it is dark red or port wine colored and usually does not clot. The uterus generally enlarges because of an accumulation of blood at the placental site. It is difficult to assess a client for concealed hemorrhage; the fetus must first be assessed for fetal heart tones to determine viability, not for increases or decreases in the heart rate. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points.
A laboring client reports low back pain. Which intervention should the nurse recommend to the client's coach to promote the most comfort for this client? A) Instruct her to flex her knees. B) Place her in the supine position. C) Apply pressure to her back during contractions. D) Perform neuromuscular control exercises with her.
C) Apply pressure to her back during contractions. The application of back pressure combined with frequent position changes will help alleviate this discomfort. Although flexing the knees may be comfortable for some individuals, rubbing the back and alternating positions are usually more effective. The supine position places increased pressure on the back and often aggravates the pain. Neuromuscular control exercises are used to teach selective relaxation in childbirth classes; they will not relieve back pain during labor. STUDY TIP: In the first pass through the exam, answer what you know and skip what you do not know. Answering the questions you are sure of increases your confidence and saves time. This is buying you time to devote to the questions with which you have more difficulty.
A primigravida is admitted with a ruptured fallopian tube (resulting from an ectopic pregnancy), and surgery is performed to remove the fallopian tube. Which intervention should be included in the postoperative nursing care plan? A) Counseling on how to prevent another tubal pregnancy B) Administering Rho (D) immune globulin to prevent isoimmunization C) Explaining that the client may still be capable of becoming pregnant D) Telling the client to avoid douching after intercourse, because this may dislodge a fertilized egg
C) Explaining that the client may still be capable of becoming pregnant Removing a fallopian tube does not impair the ovaries' ability to release an egg, which may be fertilized in the remaining tube if it is undamaged. There is no known way to prevent future tubal pregnancies. There is no information to indicate that the client is Rh negative, requiring the administration of Rho (D) immune globulin. Liquid from a douche does not reach the fallopian tube or dislodge a fertilized egg; in addition, douching is no longer recommended at any time.
A pregnant woman with a history of heart disease visits the prenatal clinic toward the end of her second trimester. Which intervention does the nurse anticipate will be part of this client's care plan? A) Preparation for a cesarean birth B) Bed rest during the last trimester C) Prophylactic antibiotics at the time of birth D) Increasing dosages of cardiac medications as pregnancy progresses
C) Prophylactic antibiotics at the time of birth Prophylactic antibiotics are given to clients with heart disease to reduce their risk for bacterial endocarditis. A vaginal birth, with a shortened second stage and an assisted birth involving forceps or vacuum extraction, is preferred. The data do not indicate which class of heart disease the client has; if it is class I and there is no cardiac decompensation, activities may be restricted; however, bed rest is not necessary. Increasing the dosages of the client's cardiac medications may or may not be necessary; dosages are based on each individual's response to the stress imposed by pregnancy. Test-Taking Tip: Pace yourself when taking practice quizzes. Because most nursing exams have specified time limits, you should pace yourself during the practice testing period accordingly. It is helpful to estimate the time that can be spent on each item and still complete the examination in the allotted time. You can obtain this figure by dividing the testing time by the number of items on the test. For example, a 1-hour (60-minute) testing period with 50 items averages 1.2 minutes per question. The NCLEX exam is not a timed test. Both the number of questions and the time to complete the test varies according to each candidate's performance. However, if the test taker uses the maximum of 5 hours to answer the maximum of 265 questions, each question equals 1.3 minutes.
An 18-year-old primigravida at 36 weeks' gestation is admitted with a diagnosis of mild preeclampsia. What is the nurse's most important goal for the client at this time? A) Easing her anxiety B) Limiting the bleeding C) Reducing her blood pressure D) Decreasing the circulating blood volume
C) Reducing her blood pressure Treatment is directed primarily toward reducing the blood pressure and preventing seizures. Although anxiety may be present, easing it is not the priority. Bleeding is not generally a problem with preeclampsia unless abruptio placentae occurs. With preeclampsia there is already a decrease in circulating blood volume, which causes hemoconcentration and decreased organ perfusion. STUDY TIP: Record the information you find to be most difficult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traffic or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past.
A teenager at 32 weeks' gestation is hospitalized with preeclampsia. She is anorexic and appears depressed. Which comment indicates to the nurse that further exploration of the client's emotional status is indicated? A) "I'm tired of feeling so clumsy." B) "I'll be glad when I can sleep all night." C) "I dreamed my baby only had one arm." D) "I was really happy before I got pregnant."
D) "I was really happy before I got pregnant." The client's statement that she was happy before getting pregnant indicates a failure to resolve conflicting feelings about pregnancy that should have been resolved in the first trimester. The statement that she is tired of feeling clumsy is an expected feeling in the third trimester. The statement that she'll be glad when she can sleep all night is expected in the third trimester as the enlarging uterus limits the number of comfortable positions that can be assumed during sleep. Concerns about the expected infant having physical abnormalities are common in the third trimester. STUDY TIP: Enhance your organizational skills by developing a checklist and creating ways to improve your ability to retain information, such as using index cards with essential data, which are easy to carry and review whenever you have a spare moment.
A client visiting the prenatal clinic for the first time asks the nurse about the probability of having twins because her husband is one of a pair of fraternal twins. What is the appropriate response by the nurse? A) "A sonogram will tell us if there's a twin pregnancy." B) "There's a 25 percent probability of you having twins." C) "Your husband's history of being a twin increases your chance of having twins." D) "There's no greater probability of you having twins than in the general population."
D) "There's no greater probability of you having twins than in the general population." Fraternal twins may occur as a result of a hereditary trait; however, it is related to the release of two eggs during one ovulation; the fact that the father is a fraternal twin would not influence the female's ovaries to release two eggs during one ovulation. Although it is true that a sonogram will reveal the presence of twins, this response does not answer the client's question. If there is no maternal family history of twin pregnancies, this client's pregnancy with twins would be a chance occurrence equal to the probability found in the general population.
A multiparous client with a history of gestational hypertension and previous history of abruption is in the transition phase of labor. The electronic fetal monitor shows fetal bradycardia, and a change is seen in the contour of the client's abdomen. What is the nurse's priority intervention? A) Checking the client's vital signs B) Placing the client on her left side C) Immediately placing an internal scalp electrode on the fetus D) Alerting others regarding the need for immediate cesarean delivery
D) Alerting others regarding the need for immediate cesarean delivery Another nurse should be asked to notify the operating room staff, primary healthcare provider, anesthesiologist, and neonatal team to prepare. The client's nurse should monitor vital signs, watch for signs of hypotension and tachycardia, insert an indwelling catheter, and stay as calm as possible while explaining to the client that the staff are working together to bring about a safe outcome. The client is exhibiting signs of uterine rupture. An emergency cesarean birth is the priority. Vital signs may be checked immediately after another nurse has been asked to bring the team together. Placing an internal fetal monitor is a poor use of valuable time and requires a prescription from the primary healthcare provider. Client history, fetal bradycardia, and change of abdominal contour indicate uterine rupture.
During the postpartum period a client tells the nurse that she was very uncomfortable during her pregnancy because of large and painful varicose veins. In light of this information, what should the nurse's assessment include? A) Monitoring daily clotting times B) Assessing for peripheral pulses C) Monitoring daily hemoglobin values D) Assessing for signs of thrombophlebitis
D) Assessing for signs of thrombophlebitis Varicose veins predispose the client to thrombophlebitis; warmth, redness, and pain in the calf are signs of thrombophlebitis. The clotting mechanism is not affected; clot formation results because of venous pooling and decreased venous return caused by the impaired vasculature. The problem is venous, not arterial, so pulses are not affected. Hemoglobin values are affected by the amount of bleeding that occurred during the birth, which usually is not severe enough to impair circulatory competency. STUDY TIP: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience.
