A nurse is caring for a client who is at 6 weeks of gestation and has a history of cervical insufficiency in three previous fetal losses.
Which of the following interventions is the nurse's priority?
Refer the client for emotional support and resources.
Prepare the client for a cervical cerclage.
Obtain a transvaginal ultrasound.
Provide instructions on progesterone use.
The Correct Answer is C
Choice A rationale
Providing emotional support and resources is a vital part of holistic nursing care, especially for a client who has experienced three previous fetal losses. However, in the hierarchy of clinical needs, psychological support is not the immediate priority when a diagnostic assessment is required to manage the physical pregnancy. While empathy is necessary, it does not address the physiological risk of cervical insufficiency that threatens the current pregnancy at this very early 6-week gestational stage.
Choice B rationale
Preparing the client for a cervical cerclage is a definitive treatment for cervical insufficiency, but it is not the priority at 6 weeks of gestation. A cerclage is typically performed between 12 and 14 weeks of gestation once fetal viability is more certain and the risk of early miscarriage has decreased. Jumping to surgical preparation without first confirming the current status of the pregnancy and following the established diagnostic timeline is premature and skips necessary clinical assessment steps.
Choice C rationale
Obtaining a transvaginal ultrasound is the priority intervention. At 6 weeks of gestation, the nurse must first confirm the presence of a viable intrauterine pregnancy and establish an accurate baseline. Ultrasound is the gold standard for assessing cervical length and identifying any early changes in the cervix, such as funneling. Given the history of losses, documenting the current anatomical and fetal status is the first logical step before proceeding with invasive surgical interventions or medication management.
Choice D rationale
Providing instructions on progesterone use is an appropriate intervention for preventing preterm birth in some clients with a history of cervical issues. However, it is not the immediate priority at 6 weeks. Progesterone supplementation often begins later in the first or early second trimester depending on specific protocols. Before starting any pharmacological therapy, the provider must perform a physical and ultrasound assessment to verify the pregnancy's health and determine the most appropriate personalized care plan.
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Correct Answer is D
Explanation
Choice A rationale
Following the evacuation of a molar pregnancy, or hydatidiform mole, it is imperative that the patient avoids pregnancy for at least six to twelve months. This delay is necessary because a new pregnancy would cause a physiological rise in human chorionic gonadotropin (hCG) levels. This rise would make it impossible for clinicians to distinguish between a normal pregnancy and the development of gestational trophoblastic neoplasia, which is a potential cancerous complication of a mole.
Choice B rationale
Post-operative monitoring is critical after a molar pregnancy surgery. Patients require serial blood tests to monitor serum hCG levels until they return to zero and remain undetectable for a specified period. Regular follow-up appointments allow the healthcare provider to ensure that no residual trophoblastic tissue remains, which could proliferate into a choriocarcinoma. Skipping these appointments poses a severe health risk, as early detection of persistent gestational trophoblastic disease is essential for successful treatment.
Choice C rationale
A fever following surgery is not considered a normal or expected finding and often indicates an underlying complication such as a pelvic infection or endometritis. Normal body temperature ranges from 36.5 to 37.2 degrees Celsius (97.7 to 99 degrees Fahrenheit). A temperature elevation suggests the inflammatory response is reacting to a pathogen. Patients must be taught to report any fever immediately so that appropriate diagnostic tests and antibiotic therapies can be initiated to prevent sepsis.
Choice D rationale
Heavy vaginal bleeding after the evacuation of a molar pregnancy can be a sign of uterine subinvolution, retained products of conception, or the development of persistent gestational trophoblastic disease. While some spotting is expected, hemorrhage requires immediate medical evaluation to prevent hemodynamic instability and anemia. Hemoglobin levels normally range from 12 to 16 g/dL for women. Reporting heavy bleeding ensures that the provider can perform an ultrasound or other interventions to manage potential complications promptly.
Correct Answer is D
Explanation
Choice D rationale
Graves' disease is an autoimmune disorder and the most common cause of hyperthyroidism during pregnancy. It involves the production of thyroid-stimulating immunoglobulins that bind to and activate thyrotropin receptors, leading to excessive synthesis and secretion of thyroid hormones. In the context of pregnancy, maternal hyperthyroidism must be carefully managed to prevent complications like preeclampsia or thyroid storm. Graves' disease accounts for the vast majority of cases where a pregnant client exhibits suppressed TSH and elevated free T4 levels.
Choice A rationale
Hypertension is often a clinical manifestation or a complication of poorly controlled hyperthyroidism in pregnancy, but it is not the underlying cause of the thyroid dysfunction itself. The hypermetabolic state associated with excess thyroid hormone increases cardiac output and heart rate, which can lead to elevated blood pressure. In severe cases, this can progress to preeclampsia. However, when identifying the etiology of hyperthyroidism, hypertension is viewed as a systemic effect of the primary endocrine pathology rather than its source.
Choice B rationale
A decrease in T4 is the hallmark of hypothyroidism, not hyperthyroidism. In hyperthyroidism, the thyroid gland produces an excess of thyroxine (T4) and triiodothyronine (T3). Normal free T4 ranges in pregnancy are roughly 0.8 to 1.8 ng/dL, though these vary by trimester. High levels of circulating T4 suppress the pituitary gland's production of thyroid-stimulating hormone (TSH). Therefore, a laboratory finding of elevated T4 and low TSH is the expected diagnostic profile for a client with this endocrine condition.
Choice C rationale
While an increase in human chorionic gonadotropin can transiently stimulate the thyroid gland due to its structural similarity to TSH, this is usually referred to as gestational transient thyrotoxicosis. While hCG contributes to thyroid stimulation in early pregnancy, it is distinct from the clinical diagnosis of chronic hyperthyroidism caused by Graves' disease. In most cases of hyperthyroidism requiring long-term management throughout gestation, an underlying autoimmune process is the primary cause rather than the physiological influence of hCG alone.
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