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A nurse is caring for a 30-year-old female client who is at 20 weeks of gestation in the labor and delivery unit.

Exhibits

For each of the listed client findings, click to specify if the finding is consistent with ectopic pregnancy or molar pregnancy. Each finding may support more than 1 disease process.

A.

Client report of abdominal pain

B.

Blood pressure

C.

Ultrasound results

D.

Perineal pad findings

Answer and Explanation

The Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"B"}}

Rationales for Each Condition

Molar Pregnancy

  1. Abdominal Pain: In a molar pregnancy, the uterus enlarges disproportionately due to abnormal trophoblastic growth. This excessive expansion can cause discomfort or mild cramping.
  2. Blood Pressure: Molar pregnancies can be associated with gestational trophoblastic disease, which may lead to preeclampsia-like symptoms. However, this client’s blood pressure is currently within normal limits (120/78 mm Hg), so severe hypertension has not yet developed.
  3. Ultrasound Findings: The presence of grape-like vesicles within the uterus and the absence of a fetal heartbeat are hallmark findings of a molar pregnancy, indicating abnormal placental tissue proliferation.
  4. Perineal Pad Findings: The passage of small clear vesicles is a characteristic feature of a molar pregnancy, distinguishing it from other causes of vaginal bleeding in pregnancy.

Ectopic Pregnancy

  1. Abdominal Pain: Ectopic pregnancies often cause sharp lower abdominal pain due to tubal rupture or irritation. However, in this case, the client’s pain is mild and less suggestive of tubal rupture.
  2. Blood Pressure: If an ectopic pregnancy ruptures, hypotension due to internal bleeding would be expected. Since the client’s blood pressure is normal, this finding does not support an ectopic pregnancy.
  3. Ultrasound Findings: The absence of a fetal heartbeat and vesicular structures inside the uterus make ectopic pregnancy unlikely, as ectopic pregnancies typically occur in the fallopian tube.
  4. Perineal Pad Findings: Ectopic pregnancies rarely cause the passage of vesicular tissue, further suggesting that this is not an ectopic pregnancy.


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Related Questions

Correct Answer is D

Explanation

Choice A rationale

Rapid plasma regain is not a standard laboratory test associated with hyperemesis gravidarum. Hyperemesis gravidarum is characterized by severe nausea and vomiting leading to dehydration and electrolyte imbalances.

Choice B rationale

A urine culture is used to detect urinary tract infections, which are not a primary concern in hyperemesis gravidarum unless specifically indicated by symptoms of a UTI.

Choice C rationale

Prothrombin time (PT) and other coagulation studies assess blood clotting. While severe dehydration and malnutrition from hyperemesis gravidarum could theoretically affect coagulation, it is not a routine initial test to anticipate.

Choice D rationale

Urine ketones are a key laboratory finding in hyperemesis gravidarum. Due to persistent vomiting and inadequate oral intake, the body starts to break down fat for energy, leading to ketonuria. The presence of ketones in the urine indicates starvation and the need for intravenous fluids and nutritional support.

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

The nurse should monitor the client’s temperature due to the risk of chorioamnionitis.

Rationale for correct answers

Temperature monitoring is crucial for detecting chorioamnionitis, an infection of the amniotic sac, which is a major risk following preterm premature rupture of membranes (PPROM). PPROM increases susceptibility to ascending bacterial infection, leading to inflammation. Fever (>38°C or 100.4°F) is a primary diagnostic criterion.

Chorioamnionitis presents with maternal fever, fetal tachycardia (>160/min), uterine tenderness, and foul-smelling amniotic fluid. The client's normal temperature now (36.7°C) requires ongoing monitoring, as infection could develop rapidly.

Rationale for incorrect Response 1 options

  • Magnesium levels: Magnesium sulfate is used for seizure prophylaxis in eclampsia or for neuroprotection in preterm labor. This client has no signs of either condition.
  • Fundal height: Measurement assesses fetal growth and amniotic fluid levels; it is not a direct indicator of infection risk.
  • Clotting factors: No evidence of coagulopathy or bleeding abnormalities; coagulation profile is normal.

Rationale for incorrect Response 2 options

  • Concealed hemorrhage: No signs of placental abruption (painful bleeding, rigid abdomen). Normal hemoglobin (12.0 g/dL) supports this.
  • Seizures: No hypertensive crisis or neurological symptoms suggestive of eclampsia.
  • Disseminated intravascular coagulation (DIC): No abnormal coagulation markers or evidence of excessive bleeding.

Take-home points

• PPROM increases the risk of chorioamnionitis, a serious intrauterine infection. • Fever monitoring is essential, as maternal fever is an early indicator of infection. • Antibiotics are given prophylactically to reduce chorioamnionitis risk in PPROM. • Differentiation from placental abruption, eclampsia, and DIC is based on clinical and laboratory findings.

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