A client had undergone suction curettage for the removal of a hydatidiform mole (gestational trophoblastic disease). What would the nurse emphasize when planning for the client's discharge?
The reasons for postponing another pregnancy for at least three months.
The necessity of at least six weeks of follow-up care.
The risk factors for the development of another hydatidiform mole.
The basis for chemotherapy if the human chorionic gonadotropin levels decrease.
The Correct Answer is A
Choice A rationale
Following the evacuation of a hydatidiform mole, the client is at risk for developing gestational trophoblastic neoplasia (GTN). Pregnancy must be avoided for at least six to twelve months to ensure that any persistent or new human chorionic gonadotropin (hCG) elevation is due to GTN and not a new normal pregnancy. Three months is the minimum duration often discussed.
Choice B rationale
Follow-up care, including weekly hCG level monitoring until the level is undetectable, then monthly for six to twelve months, is crucial for early detection of malignant transformation (choriocarcinoma). Therefore, six weeks of follow-up care is insufficient for proper surveillance and risk management.
Choice C rationale
A history of a hydatidiform mole is indeed a risk factor for recurrence, with a recurrence rate of approximately 1–2%. However, the immediate priority for discharge teaching focuses on preventing the hCG confounding effect of a new pregnancy and ensuring compliance with the necessary hCG monitoring protocol.
Choice D rationale
Chemotherapy is indicated if the hCG levels plateau or increase, or if there is evidence of metastasis, rather than if they decrease. A decrease in hCG levels is the desired outcome after evacuation and indicates successful treatment without the need for chemotherapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Increasing intravenous fluids (IVFs) addresses hypovolemia which can be a cause of late decelerations due to reduced uteroplacental perfusion, but the provided scenario describes an isolated deceleration lasting only 15 seconds, which is classified as a non-reassuring variable deceleration if the drop is ≥ 15 beats/minute. A variable deceleration is caused by umbilical cord compression, which is best managed by position change.
Choice B rationale
Placing the client's legs knee to chest (or deep Trendelenburg) is a specific intervention reserved for a diagnosed umbilical cord prolapse to relieve pressure on the prolapsed cord until an emergency delivery can occur. The brief, isolated nature of the deceleration described does not indicate a frank cord prolapse, and this extreme position is not the first-line intervention for a typical variable deceleration.
Choice C rationale
Assisting the client to change positions (e.g., from supine to lateral, or left to right lateral) is the most effective initial intervention for variable decelerations. These decelerations are caused by umbilical cord compression, and changing the maternal position often relieves the pressure on the cord, thus restoring normal fetal circulation and promptly resolving the transient drop in the fetal heart rate.
Choice D rationale
Administering oxygen via face mask addresses potential maternal hypoxemia that could lead to fetal hypoxia and subsequent late decelerations, or prolonged decelerations that compromise fetal oxygenation. For a brief, isolated variable deceleration that quickly resolves (as implied by the short duration), oxygen is not the immediate or primary intervention; position change is more critical.
Correct Answer is ["A","B"]
Explanation
Choice A rationale
Postpartum hemorrhage (PPH) is a significant risk for this client due to several factors including a macrosomic neonate (birth weight >4000 grams), which causes overdistention of the uterus. Uterine overdistention stretches the muscle fibers, impairing the uterus's ability to contract effectively (uterine atony) after birth, which is the leading cause of PPH (normal blood loss range: ≤ 500 mL for vaginal birth).
Choice B rationale
A rapid labor (4 hours) and the birth of a macrosomic neonate (4200 grams) increase the risk of vaginal lacerations and tears to the soft tissues of the birth canal. The rapid passage of a large fetal head/shoulder diameter can cause uncontrolled and forceful tearing, often extending into the perineal musculature, leading to potential complications and excessive blood loss.
Choice C rationale
Uterine inversion, the collapse of the fundus into the endometrial cavity, is a rare but severe complication. While associated with factors like aggressive cord traction or fundal pressure, this client's history of macrosomia and rapid labor primarily increases the risk for uterine atony and lacerations, making inversion a much less likely, though possible, complication.
Choice D rationale
Postpartum hypertension (PHTN) is generally related to a history of pre-eclampsia or chronic hypertension. This client's presentation of macrosomia and rapid labor primarily increases the risk for mechanical/anatomical complications like uterine atony and lacerations rather than a primary vasospastic or systemic vascular disorder such as PHTN.
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