A patient is being discharged from the hospital after the evacuation of a molar pregnancy. The nurse recognizes that additional discharge teaching is required when the patient makes which statement?

"I don't need to see the doctor for another year when I will come back for follow-up

I will use contraception for the next year

I need to be monitored for choriocarcinoma during the next year

I am so sad that I lost this baby

Answer and Explanation

The Correct Answer is A

A. "I don't need to see the doctor for another year when I will come back for follow-up." This statement is incorrect because close follow-up is essential after a molar pregnancy to monitor for gestational trophoblastic disease (GTD) or choriocarcinoma. Regular hCG level monitoring is required weekly until levels are undetectable, then monthly for at least 6–12 months. Delaying follow-up for a year could lead to missed complications.

B. "I will use contraception for the next year." This statement is correct. Pregnancy should be avoided for at least one year after a molar pregnancy to ensure accurate monitoring of hCG levels. A rising hCG level could indicate malignant transformation rather than a new pregnancy.

C. "I need to be monitored for choriocarcinoma during the next year." This statement is correct. Choriocarcinoma is a potential complication of molar pregnancy, and early detection through serial hCG monitoring is crucial. Any persistent or rising hCG levels may indicate malignancy requiring chemotherapy.

D. "I am so sad that I lost this baby." This statement is understandable. A molar pregnancy is an emotionally distressing event, and feelings of grief and loss are valid. Emotional support, counseling, or support groups may be beneficial for the patient’s mental well-being.

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Correct Answer is A

Explanation

A. Perform vaginal exam and apply upward digital pressure to the presenting part. A prolapsed umbilical cord is an obstetric emergency that can lead to cord compression and fetal hypoxia. The priority intervention is for the nurse to manually lift the presenting part (usually the fetal head) off the cord to relieve pressure and restore blood flow. The nurse should maintain this position until an emergency cesarean section is performed.

B. Immediately turn the client to her side. Positioning changes, such as the knee-chest or Trendelenburg position, can help relieve pressure on the cord, but they are secondary to manually lifting the presenting part. While turning the client may assist, it is not the most immediate life-saving action.

C. Call the physician immediately. While notifying the provider is essential, relieving pressure on the umbilical cord takes priority. Delaying intervention to make a call could result in prolonged fetal hypoxia and compromise.

D. Place a moist, clean towel over the cord to prevent drying. Covering the cord with a moist towel helps prevent vasospasm and drying, but it does not relieve the compression that is cutting off oxygen to the fetus. The priority is to relieve pressure on the cord first before taking other measures.

A. Maternal temperature of 101.4 F B. Maternal blood pressure of 138/89 C. Change in fetal baseline heart rate from 125 to 90 D. Change in the maternal pulse from 80 to 93

Correct Answer is C

Explanation

A. Maternal temperature of 101.4°F. A fever may indicate infection (chorioamnionitis), but it is not an immediate reason to stop oxytocin. The nurse should monitor for additional signs of infection and notify the provider, but the priority is fetal well-being.

B. Maternal blood pressure of 138/89. This blood pressure is not critically high and does not indicate a hypertensive crisis. Oxytocin can cause fluid retention and slight blood pressure changes, but this reading alone does not require stopping the infusion.

C. Change in fetal baseline heart rate from 125 to 90. A decrease in fetal heart rate (bradycardia) is a sign of fetal distress and requires immediate intervention. Oxytocin can cause uterine hyperstimulation, leading to decreased placental perfusion and fetal hypoxia. The priority is to stop oxytocin, reposition the mother, provide oxygen, and notify the provider.

D. Change in the maternal pulse from 80 to 93. A mild increase in heart rate is not uncommon during labor and may be due to pain, anxiety, or IV fluids. It does not indicate an emergency or the need to stop oxytocin.

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A patient is being discharged from the hospital after the evacuation of a molar pregnancy. The nurse recognizes that additional discharge teaching is required when the patient makes which statement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse discovers a loop of the umbilical cord protruding through the vagina when preparing to perform a vaginal examination. The priority intervention is to:

Correct Answer is A

Explanation

A nurse is monitoring the labor of a patient who is receiving IV oxytocin (Pitocin) at 6 ml/hr. Which of the following clinical signs would lead the nurse to stop the infusion?

Correct Answer is C

Explanation

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