A client at 20 weeks of gestation presents with painless cervical dilation. What is the likely diagnosis for this client?
Cervical insufficiency
Placenta previa
Ectopic pregnancy
Preterm labor
The Correct Answer is A
Cervical insufficiency involves the premature, painless dilation of the cervix, typically during the second trimester. The etiology is linked to structural weaknesses in the cervical stroma or collagen defects that prevent the cervix from remaining closed under the weight of the growing fetus. This often leads to spontaneous abortion or preterm delivery.
A. Cervical insufficiency: The hallmark of this condition is dilation occurring without the presence of painful uterine contractions. It is frequently diagnosed after a history of mid-trimester losses. Management typically involves the surgical placement of a cervical cerclage to provide mechanical support.
B. Placenta previa: This condition occurs when the placenta partially or completely covers the internal cervical os. While it can cause painless vaginal bleeding, it does not typically cause premature cervical dilation at 20 weeks. It is diagnosed via ultrasonography rather than physical dilation findings.
C. Ectopic pregnancy: An ectopic pregnancy implants outside the uterus and almost always presents with pain and bleeding in the first trimester. By 20 weeks, an untreated ectopic pregnancy would have already ruptured, causing hemorrhagic shock. It does not involve the cervix dilating painlessly.
D. Preterm labor: Labor is defined by regular, painful uterine contractions that result in cervical change. Because the question specifies the dilation is painless, labor is ruled out as the primary diagnosis. True labor requires the expulsive force of myometrial contractions to open the cervix.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rho(D) immune globulin provides passive immunization to Rh-negative mothers to prevent the development of permanent anti-D antibodies. If fetal erythropoiesis results in Rh-positive cells entering maternal circulation, the mother's immune system may recognize them as foreign. This prevents isoimmunization and subsequent hemolytic disease.
A. Increase iron levels: Rho(D) immune globulin is an antibody preparation and does not contain iron or influence hemoglobin synthesis. Iron deficiency is managed with oral supplements or parenteral iron sucrose. It has no role in correcting maternal anemia or mineral storage.
B. Prevent infection: The medication is not an antibiotic or an antiviral agent and does not protect against pathogenic microorganisms. Its sole function is to modulate the immune response to specific red blood cell antigens. It does not bolster general systemic immunity.
C. Prevent Rh sensitization: The primary goal is to hide fetal Rh-positive antigens from the maternal immune system. By clearing these cells before maternal B-cells can react, the drug prevents the production of IgG antibodies. This protects the current and future pregnancies from erythroblastosis fetalis.
D. Improve fetal growth: While preventing fetal anemia indirectly supports health, Rho(D) immune globulin is not a growth-promoting factor. Fetal growth is dependent on placental function and maternal nutrition. The medication specifically targets immunological compatibility rather than somatic developmental rates.
Correct Answer is D
Explanation
Hemoglobin A1c (HbA1c) measures the percentage of glycated hemoglobin, reflecting the mean plasma glucose over the preceding 8 to 12 weeks. In pregnancy, an HbA1c of 7.5% indicates significant hyperglycemia and increases the risk of congenital anomalies or macrosomia. It serves as a biomarker for metabolic control during organogenesis.
A. Dehydration: While acute hyperglycemia can lead to osmotic diuresis and subsequent volume depletion, a 3-month average (HbA1c) is not a measure of acute hydration status. Dehydration is better assessed through clinical signs and urine specific gravity. HbA1c specifically tracks glucose saturation.
B. Hypoglycemia risk: A high HbA1c level indicates chronic high blood sugar, the opposite of hypoglycemia. While the treatment of diabetes can lead to low blood sugar, the lab value itself confirms uncontrolled hyperglycemia. High values suggest a lack of glycemic stability.
C. Infection: Chronic hyperglycemia can impair the maternal immune response, making the client more susceptible to vaginal candidiasis or urinary tract infections. However, the HbA1c test is a specific measure of glucose metabolism, not an inflammatory marker or white blood cell count.
D. Poor long-term glucose control: An HbA1c of 7.5% is well above the recommended gestational target (typically < 6.0-6.5%). This confirms that the client's blood sugar has been consistently elevated for several months. It highlights the need for immediate insulin titration or dietary modifications.
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