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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 B

Explanation

Choice A rationale

Thoroughly cooking meat to an internal temperature of 160°F (71°C) kills the Toxoplasma gondii parasite, thus preventing transmission. This is a recommended measure to prevent toxoplasmosis during pregnancy.

Choice B rationale

Drinking unpasteurized milk poses a risk of exposure to various pathogens, including Toxoplasma gondii, as pasteurization is a process that kills harmful microorganisms. Pregnant women should avoid unpasteurized dairy products to reduce the risk of infection. This statement indicates a need for further instruction as it suggests an unsafe practice.

Choice C rationale

Cat feces can contain oocysts of Toxoplasma gondii. Avoiding contact with materials potentially contaminated with cat feces, such as litter boxes or garden soil, is a crucial measure to prevent toxoplasmosis.

Choice D rationale

Raw meat can be contaminated with Toxoplasma gondii. Avoiding touching mucous membranes of the mouth or eyes while handling raw meat and washing hands thoroughly afterwards prevents the parasite from entering the body. This is a recommended preventive measure.

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

Explanation

The nurse should anticipate a provider prescription for pyridoxine due to the client’s severe dehydration.

Rationale for correct answers

Pyridoxine (vitamin B6) is recommended for nausea and vomiting in pregnancy (NVP), commonly known as hyperemesis gravidarum (HG), especially in patients with persistent symptoms leading to dehydration. Severe dehydration is confirmed by elevated urine specific gravity (normal: 1.002–1.030), low sodium (normal: 135–145 mEq/L), and positive ketones, indicating excessive vomiting and malnutrition.

Rationale for incorrect Response 1 options

  • Antibiotics: There is no evidence of infection; urinalysis and WBC count are within normal limits.
  • Magnesium sulfate: Used for eclampsia or preterm labor prevention, not for HG.
  • Oxytocin: Stimulates uterine contractions and is contraindicated during early pregnancy unless labor induction is required.

Rationale for incorrect Response 2 options

  • Urinary tract infection: No leukocytes or nitrites in urine, and WBC count is normal (4,500–11,000/mm³).
  • Preeclampsia: No proteinuria or hypertension (≥140/90 mm Hg).
  • Preterm labor: No uterine contractions or cervical changes.

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