Complications in Early Pregnancy

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A nurse is caring for a client who is 32 weeks gestation who comes to the emergency department for painful bleeding. Which is the priority nursing assessment?

  • A. Monitor for contractions
  • B. Assess pain level
  • C. Assess for hemorrhage
  • D. Provide emotional support
Correct Answer: C

Rationale: The correct priority nursing assessment in this scenario is to assess for hemorrhage (Choice C). This is crucial because painful bleeding in a client at 32 weeks gestation could indicate a potential life-threatening situation such as placental abruption or placenta previa. Assessing for hemorrhage involves checking the amount and type of bleeding, vital signs, and signs of shock. It is essential to identify and address hemorrhage promptly to prevent adverse outcomes for both the mother and the baby.

Monitoring for contractions (Choice A) is important but assessing for hemorrhage takes precedence due to the immediate risk it poses. Assessing the pain level (Choice B) is secondary to assessing for hemorrhage in this case. Providing emotional support (Choice D) is important but should come after ensuring the client's physical well-being is addressed.

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The nurse is providing discharge instructions to a 28-year-old client who received methotrexate for an ectopic pregnancy. Which should the discharge instructions include?

  • A. Make sure to take folic acid
  • B. Make an appointment to see her provider in 6 weeks
  • C. Flush the toilet twice after she urinates for the next 24 hours
  • D. Resume all activity in 48 hours
Correct Answer: C

Rationale: The correct answer is C: Flush the toilet twice after she urinates for the next 24 hours. Methotrexate is excreted in urine and can be harmful if it comes into contact with others. Flushing the toilet twice helps to minimize the risk of exposure to others. Choice A is incorrect because although folic acid supplementation may be necessary with methotrexate, it is not the priority in this scenario. Choice B is incorrect as the client should be advised to seek immediate medical attention if any concerning symptoms occur, rather than waiting for 6 weeks. Choice D is incorrect as the client needs to avoid certain activities for a period of time after receiving methotrexate to prevent complications.

The nurse is caring for a client with a suspected hydatidiform mole. Based on the diagnosis, what does the nurse anticipate? Select all that apply.

  • A. Dark brown vaginal bleeding
  • B. Strong fetal heart tones
  • C. Fundal height larger than expected
  • D. Elevated blood pressure
Correct Answer: B

Rationale: Step-by-step rationale:
1. Hydatidiform mole is a type of gestational trophoblastic disease.
2. It results in the abnormal growth of placental tissue instead of a fetus.
3. As there is no fetus, there won't be any fetal heart tones.
4. Therefore, the nurse anticipates absence of fetal heart tones.

Summary:
A: Dark brown vaginal bleeding is not specific to hydatidiform mole.
C: Fundal height larger than expected is not a typical sign of hydatidiform mole.
D: Elevated blood pressure is not directly associated with hydatidiform mole.

The nurse is caring for a client in labor who is HIV positive. Which nursing care should be included?

  • A. Administering antiretroviral drugs as ordered
  • B. Assisting the woman on a labor ball to help with natural descent of the fetus
  • C. Handling the newborn with gloves until it receives its first bath
  • D. Encouraging the mother to breastfeed soon after delivery
Correct Answer: A

Rationale: The correct answer is A: Administering antiretroviral drugs as ordered. This is crucial in preventing vertical transmission of HIV from mother to child during childbirth. Antiretroviral therapy reduces the viral load in the mother's blood and bodily fluids, decreasing the risk of transmission. Choice B is beneficial for labor progress but not directly related to HIV care. Choice C is unnecessary as HIV is not transmitted through skin contact. Choice D is contraindicated as breastfeeding can transmit HIV from mother to child.

The nurse is caring for a patient who is receiving magnesium sulfate for pre-eclampsia. Which assessments will be of the highest priority?

  • A. Assessing lung sounds
  • B. Assessing blood sugar level
  • C. Encouraging fluid intake
  • D. Assessing for pitting edema
Correct Answer: A

Rationale: The correct answer is A: Assessing lung sounds. This is of highest priority because magnesium sulfate can lead to respiratory depression. Assessing lung sounds helps monitor for signs of respiratory distress, such as decreased breath sounds or crackles. Assessing blood sugar level (B) is important but not as urgent as respiratory status. Encouraging fluid intake (C) is important for hydration but not as critical as respiratory assessment. Assessing for pitting edema (D) is relevant for monitoring fluid retention but not as immediate as assessing lung sounds for respiratory compromise.

A 17-year-old client has been admitted to the hospital for hyperemesis gravidarum. Which factor likely caused her condition?

  • A. Having high levels of hCG
  • B. Having high blood pressure
  • C. Being an adolescent
  • D. Being underweight
Correct Answer: C

Rationale: The correct answer is C: Being an adolescent. Adolescents are more prone to hyperemesis gravidarum due to several factors such as hormonal changes, increased stress, poor diet, and lack of prenatal care awareness. Being an adolescent increases the risk of complications during pregnancy leading to hyperemesis gravidarum. High levels of hCG (choice A) are a symptom rather than a cause of hyperemesis gravidarum. High blood pressure (choice B) and being underweight (choice D) are not directly linked to the development of hyperemesis gravidarum in adolescents.

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