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Questions and Answers
A client who has undergone a McDonald procedure asks why the sutures need to be removed around the 37th-38th week of pregnancy. What is the most appropriate response?
A client who has undergone a McDonald procedure asks why the sutures need to be removed around the 37th-38th week of pregnancy. What is the most appropriate response?
- The sutures are removed to allow for vaginal delivery, preventing complications during labor. (correct)
- Suture removal is necessary to prevent infection as the end of pregnancy nears.
- Leaving the sutures in place can cause discomfort and restrict fetal movement in late pregnancy.
- Removing the sutures allows for a more accurate assessment of fetal lung maturity prior to delivery.
Following a cervical cerclage, a patient reports increased pelvic pressure and persistent, painful contractions. What is the priority nursing intervention?
Following a cervical cerclage, a patient reports increased pelvic pressure and persistent, painful contractions. What is the priority nursing intervention?
- Administer a prescribed analgesic to manage the pain.
- Reposition the patient in a modified Trendelenburg position.
- Assess maternal vital signs, fetal heart rate, and signs of labor or PROM. (correct)
- Prepare the patient for immediate suture removal.
A nurse is providing discharge instructions to a client after a cervical cerclage. Which statement indicates the best understanding of the discharge instructions?
A nurse is providing discharge instructions to a client after a cervical cerclage. Which statement indicates the best understanding of the discharge instructions?
- "I will maintain strict bed rest for the remainder of my pregnancy."
- "I should expect some mild spotting for a couple of weeks after the procedure."
- "I can resume all normal activities, including heavy lifting, immediately."
- "I need to report any signs of labor, such as contractions or rupture of membranes, immediately." (correct)
A client diagnosed with an ectopic pregnancy presents with sudden, severe abdominal pain and dizziness. Which assessment finding would be most indicative of a tubal rupture?
A client diagnosed with an ectopic pregnancy presents with sudden, severe abdominal pain and dizziness. Which assessment finding would be most indicative of a tubal rupture?
A client is admitted with a suspected ectopic pregnancy. Which of the following assessment findings would be most concerning and require immediate intervention?
A client is admitted with a suspected ectopic pregnancy. Which of the following assessment findings would be most concerning and require immediate intervention?
A client with a history of pelvic inflammatory disease (PID) is being evaluated for infertility. Which of the following conditions associated with PID increases her risk for ectopic pregnancy?
A client with a history of pelvic inflammatory disease (PID) is being evaluated for infertility. Which of the following conditions associated with PID increases her risk for ectopic pregnancy?
A patient presents with sharp abdominal pain, vaginal spotting, and a positive pregnancy test. Quantitative hCG levels are lower than expected for the gestational age. An ultrasound fails to visualize an intrauterine pregnancy. What condition is most likely?
A patient presents with sharp abdominal pain, vaginal spotting, and a positive pregnancy test. Quantitative hCG levels are lower than expected for the gestational age. An ultrasound fails to visualize an intrauterine pregnancy. What condition is most likely?
A client diagnosed with a hydatidiform mole is undergoing HCG titer monitoring. What is the primary rationale for this continuous monitoring?
A client diagnosed with a hydatidiform mole is undergoing HCG titer monitoring. What is the primary rationale for this continuous monitoring?
A nurse is reviewing the post-operative orders for a client who underwent a Shirodkar procedure. Which position is the client MOST likely to be placed in immediately following the surgery?
A nurse is reviewing the post-operative orders for a client who underwent a Shirodkar procedure. Which position is the client MOST likely to be placed in immediately following the surgery?
A client with a confirmed molar pregnancy exhibits a significantly elevated HCG level of 1.5 million IU/24hrs. Apart from the immediate evacuation of the uterine contents, what additional intervention is most important, considering the HCG level?
A client with a confirmed molar pregnancy exhibits a significantly elevated HCG level of 1.5 million IU/24hrs. Apart from the immediate evacuation of the uterine contents, what additional intervention is most important, considering the HCG level?
Following suction curettage for a molar pregnancy, a client receives instructions regarding contraception. What is the primary reason for advising the client to avoid pregnancy for at least one year?
Following suction curettage for a molar pregnancy, a client receives instructions regarding contraception. What is the primary reason for advising the client to avoid pregnancy for at least one year?
A nurse is providing care for a client diagnosed with incompetent cervix. Which assessment finding is most indicative of this condition?
A nurse is providing care for a client diagnosed with incompetent cervix. Which assessment finding is most indicative of this condition?
A 25-year-old female at 22 weeks gestation presents with painless vaginal bleeding and pelvic pressure. Her history includes two prior D&C procedures. Which of the following conditions should the nurse suspect?
A 25-year-old female at 22 weeks gestation presents with painless vaginal bleeding and pelvic pressure. Her history includes two prior D&C procedures. Which of the following conditions should the nurse suspect?
A client at 18 weeks gestation is diagnosed with incompetent cervix. Considering the typical management approach for this condition, which intervention would the nurse anticipate?
A client at 18 weeks gestation is diagnosed with incompetent cervix. Considering the typical management approach for this condition, which intervention would the nurse anticipate?
What is the significance of 'lightening' in the context of AOG (Age of Gestation) determination using Bartholomew's Rule?
What is the significance of 'lightening' in the context of AOG (Age of Gestation) determination using Bartholomew's Rule?
A client's fundal height is measured at the umbilicus. According to Bartholomew's rule, this measurement suggests an approximate gestational age of:
A client's fundal height is measured at the umbilicus. According to Bartholomew's rule, this measurement suggests an approximate gestational age of:
Flashcards
Positive Pregnancy Test
Positive Pregnancy Test
Initial indication of pregnancy, detected through urine or blood tests.
HCG Levels in Molar Pregnancy
HCG Levels in Molar Pregnancy
HCG levels can reach 1-2 million IU/24hrs in a molar pregnancy, causing excessive nausea.
Triad Signs of Molar Pregnancy
Triad Signs of Molar Pregnancy
Includes rapid uterine enlargement, brownish vaginal bleeding, high HCG levels.
Evacuation by Suction Curettage
Evacuation by Suction Curettage
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Incompetent Cervix
Incompetent Cervix
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Assessment Findings for Incompetent Cervix
Assessment Findings for Incompetent Cervix
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Complications of Molar Pregnancy
Complications of Molar Pregnancy
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HCG Monitoring After Molar Pregnancy
HCG Monitoring After Molar Pregnancy
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Cervical Cerclage
Cervical Cerclage
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McDonald Procedure
McDonald Procedure
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Shirodkar Procedure
Shirodkar Procedure
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Post Cerclage Surgery Care
Post Cerclage Surgery Care
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Ectopic Pregnancy
Ectopic Pregnancy
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Tubal Ectopic Pregnancy
Tubal Ectopic Pregnancy
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Cullen's Sign
Cullen's Sign
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Kehr’s Sign
Kehr’s Sign
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Study Notes
Assessment Findings
- Positive pregnancy test
- Excessive nausea and vomiting (due to high HCG levels)
- Abdominal cramping (uterine distension)
- Ultrasound shows grape-like growth (snowflake pattern)
- No viable fetus or embryonic heart beat detected
- Vaginal bleeding (brownish, intermittent)
- High HCG levels (1-2 million IU/24 hours)
Diagnosis
- Triad signs: rapid uterine enlargement, vaginal bleeding, high HCG levels
- Possible molar pregnancy (based on ultrasound findings)
Laboratory and Diagnostic Studies
- HCG levels are extremely high (abnormally high for gestational age)
- Ultrasound shows characteristics of molar growth
Treatment
- Evacuation (suction curettage)
- Hysterectomy (if not treated early)
- HCG titer monitoring for 1 year
- Replacement of blood, fluid and plasma
- Chemotherapy (if malignancy is suspected)
- Chest X-ray (to check for early metastasis)
Complications
- Choriocarcinoma
- Hemorrhage
- Uterine perforation
- Infection
Nursing Management
- Advise bed rest
- Monitor vital signs, blood loss, and tissue/molar passage
- Maintain fluid and electrolyte balance
- Prepare for possible D&C or hysterectomy
- Emphasize no further pregnancies
- Use reliable contraception
- Follow-up HCG measurement for one year
AOG Determination
- Estimate gestational age (AOG) by fundus position in the abdominal cavity (Bartholomew's rule)
- Fundus position relates to the lightening process
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Description
This covers the diagnosis and management of molar pregnancy, characterized by symptoms like high HCG and abnormal uterine growth. Treatment includes evacuation, monitoring, and potential chemotherapy to prevent complications such as choriocarcinoma.
