A nurse is assisting in the care of a client at 35 weeks of gestation who has preeclampsia with severe features and is scheduled for an immediate induction of labor after the manifestations worsened. The client is upset because the provider has disregarded their birth plan.
Which of the following considerations should the nurse implement for the client?

Expectant management protocols.

Method of birth.

Shared decision-making.

Antenatal steroid administration.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Expectant management protocols involve close monitoring and delaying delivery to allow for fetal maturation, typically used in stable preeclampsia before 34 weeks. However, this client has preeclampsia with severe features and worsening manifestations at 35 weeks, making immediate delivery the medically indicated course of action to prevent maternal stroke or seizure. Expectant management is no longer appropriate when the maternal condition is deteriorating, as the only definitive cure for the disease is delivery.

Choice B rationale

The method of birth refers to the choice between a vaginal delivery and a cesarean section. While this is an important clinical decision, the question focuses on the psychological distress of the client regarding their disregarded birth plan. Simply deciding the method of birth does not address the lack of autonomy the client feels. The medical priority is the induction for safety, but the nurse must find ways to integrate the client's preferences within those safety constraints.

Choice C rationale

Shared decision-making is a collaborative process that allows the client and healthcare team to make decisions together, even in emergency or high-risk situations. By implementing this, the nurse can explain the medical necessity of the induction while asking the client which parts of their original birth plan can still be honored, such as lighting, music, or support persons. This reduces the client's sense of powerlessness and ensures they remain an active participant in their care.

Choice D rationale

Antenatal steroid administration, such as betamethasone, is used to enhance fetal lung maturity in pregnancies less than 34 weeks of gestation when preterm birth is imminent. Since this client is currently at 35 weeks of gestation, the benefit of steroids is significantly diminished, and the urgent need for delivery due to worsening severe preeclampsia features takes precedence. Administering steroids does not address the client's emotional distress or the conflict regarding the birth plan.

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Correct Answer is B

Explanation

Choice A rationale

Induction of labor at 36 weeks is not a standard requirement for clients with thrombophilia unless other obstetric complications like severe preeclampsia or fetal growth restriction are present. Late preterm delivery carries risks of respiratory distress and jaundice for the neonate. Management usually focuses on anticoagulation therapy until the onset of labor or a scheduled induction closer to full term, typically between 39 and 40 weeks, to ensure fetal lung maturity and better neonatal outcomes.

Choice B rationale

Thrombophilia in pregnancy significantly increases the risk of fetal loss, including recurrent miscarriage and stillbirth. The hypercoagulable state can lead to the formation of microthrombi within the placental vasculature, which impairs uteroplacental perfusion. Reduced blood flow restricts the delivery of oxygen and essential nutrients to the developing fetus. This ischemic environment can result in placental abruption, intrauterine growth restriction, or fetal death, necessitating close monitoring and often pharmacological intervention with heparin-based medications.

Choice C rationale

While fetal surveillance is necessary for high-risk pregnancies, starting weekly non-stress tests specifically at 36 weeks is not the universal protocol for thrombophilia alone. The timing and frequency of antenatal testing are individualized based on the specific type of thrombophilia and the presence of other risk factors. Non-stress tests assess the fetal heart rate pattern in response to movement, providing data on fetal oxygenation. If placental insufficiency is suspected earlier, testing might begin sooner than 36 weeks.

Choice D rationale

Weekly fetal monitoring typically begins between 32 and 34 weeks of gestation for clients with thrombophilia to detect early signs of placental insufficiency. Monitoring often includes non-stress tests and biophysical profiles to evaluate fetal well-being. By 32 weeks, the risk of placental vascular complications increases as the metabolic demands of the fetus grow. Early detection of fetal distress allows for timely interventions, such as adjusting medication or planning for delivery if the intrauterine environment becomes unsafe.

A. The client is 20 years of age. B. This is the client's first pregnancy. C. The client previously had an induced abortion. D. The client has a history of infertility.

Correct Answer is D

Explanation

Choice A rationale

Maternal age at the extremes of the reproductive spectrum is a known risk factor for hydatidiform mole. Specifically, women younger than 15 years or older than 35 to 40 years are at the highest risk. A 20-year-old client falls within the typical low-risk age range for this gestational trophoblastic disease. The biological mechanism involves higher rates of abnormal fertilization or gamete quality at very young or advanced maternal ages, which is not applicable here.

Choice B rationale

Parity does not serve as a primary independent risk factor for the development of a molar pregnancy. Both primigravida and multigravida clients can develop this condition, which results from an abnormal fertilization event where the paternal genetic material duplicates or two sperm fertilize an empty egg. While previous obstetric history is important, the status of being in a first pregnancy does not specifically increase the baseline physiological risk for trophoblastic proliferation compared to subsequent pregnancies.

Choice C rationale

While a history of miscarriage or spontaneous pregnancy loss may slightly correlate with future molar pregnancies in some studies, a history of a single induced abortion is not considered a primary or significant risk factor for hydatidiform mole. Molar pregnancies are chromosomal accidents occurring at the time of conception. Previous elective terminations do not typically alter the genetic or hormonal environment of the uterus in a way that predisposes the client to molar gestations in future pregnancies.

Choice D rationale

A history of infertility is clinically associated with an increased risk of molar pregnancy. This correlation may be linked to underlying ovulatory dysfunction or the use of ovulation-inducing medications, which can occasionally result in abnormal fertilization events. Additionally, clients struggling with infertility may have chromosomal irregularities in their oocytes. Since a molar pregnancy is characterized by the overgrowth of trophoblastic tissue due to genetic errors during fertilization, any history of reproductive challenges is a relevant risk factor.

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Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a client who has thrombophilia about low molecular weight heparin. Which of the following information should the nurse include in the teaching?

Correct Answer is B

Explanation

A nurse is reviewing the medical record of a client who has a positive pregnancy test. Which of the following should the nurse identify as a finding that places the client at increased risk for a molar pregnancy?

Correct Answer is D

Explanation

A nurse is reinforcing the teaching of a newly licensed nurse about caring for clients who have type 1 and type 2 pregestational diabetes mellitus (PDM). Which of the following statements by the newly licensed nurse indicates that the reinforced teaching was effective?

A nurse is reinforcing teaching of a newly licensed nurse about hyperemesis gravidarum. Which of the following statements by the newly licensed nurse indicates the reinforced teaching was effective?

A nurse is caring for a client who is experiencing an early second-trimester spontaneous abortion and is hemodynamically stable. Which of the following prescriptions should the nurse expect the provider to prescribe?

A nurse is caring for a client who experienced a spontaneous abortion. Which of the following findings should the nurse identify as the most common cause of spontaneous abortion?

A nurse is reinforcing teaching to a client who has HELLP syndrome and who will receive a transfusion of packed red blood cells. Which of the following statements should the nurse make to reinforce the correct teaching?

A nurse is caring for a client who is at 37 weeks of gestation. Which of the following findings should the nurse identify as a risk factor for placental abruption?

A nurse is reinforcing education to the family of a client who had an eclamptic seizure. Which of the following complications of eclamptic seizure should the nurse reinforce in the teaching? (Select all that apply)

A nurse is collecting data from a client at 10 weeks of gestation who has been diagnosed with hyperemesis gravidarum. Which of the following manifestations should the nurse expect? (Select all that apply.)