A woman with a history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary health care practitioner?

Weight gain of 4 pounds in a month.

Dyspnea with walking.

Presence of striae gravidarum.

Patellar reflexes of +2.

Answer and Explanation

The Correct Answer is B

A. Weight gain of 4 pounds in a month. A weight gain of 4 pounds in a month is within the expected range for pregnancy, especially in the third trimester. While rapid or excessive weight gain could indicate fluid retention and worsening heart failure, this amount alone is not immediately concerning.

B. Dyspnea with walking. Dyspnea on exertion in a pregnant woman with congestive heart disease is a serious concern. It may indicate pulmonary congestion, worsening heart failure, or reduced cardiac output. Any increasing shortness of breath, especially with minimal activity, should be reported immediately to prevent complications like pulmonary edema or decompensated heart failure.

C. Presence of striae gravidarum. Striae gravidarum (stretch marks) are a normal skin change in pregnancy due to rapid growth and stretching of the skin. They are not related to congestive heart disease and do not require reporting.

D. Patellar reflexes of +2. A +2 deep tendon reflex (DTR) is normal and does not indicate worsening cardiac status. Reflex abnormalities are more relevant in conditions such as preeclampsia, where hyperreflexia can signal worsening disease, but they are not a concern in heart disease.

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Correct Answer is D

Explanation

A. Tell the client to take a warm shower, rest, and call back tomorrow. While rest and hydration can sometimes help with mild discomfort, this client’s symptoms—pelvic pressure, low back pain, abdominal pain, and increased vaginal discharge—are concerning for preterm labor and require immediate evaluation. Delaying care could increase the risk of preterm birth.

B. Schedule an appointment for the client at the clinic tomorrow. Waiting until the next day is not appropriate, as preterm labor is an urgent condition that needs immediate assessment to prevent premature birth. Prompt intervention may allow for tocolytic therapy or steroid administration to improve fetal lung maturity if preterm birth is imminent.

C. Instruct the client to drink cranberry juice and call if she experiences a fever. Cranberry juice is sometimes used to prevent urinary tract infections (UTIs), but this client’s symptoms are more indicative of preterm labor rather than an infection. Fever is not a defining symptom of preterm labor, and delaying care could result in complications.

D. Instruct the client to go to labor triage at the hospital for evaluation. This is the best response because the symptoms suggest possible preterm labor. Evaluation in the hospital can include cervical checks, fetal monitoring, and tests such as fetal fibronectin (fFN) to assess the risk of preterm birth. Immediate intervention can help delay labor and improve neonatal outcomes.

A. Preterm labor B. Abruptio placentae C. Pre-eclampsia D. Unruptured ectopic pregnancy

Correct Answer is D

Explanation

A. Preterm labor. Methotrexate is not used for preterm labor. Medications such as tocolytics (e.g., nifedipine, magnesium sulfate, or terbutaline) are typically used to delay labor and improve neonatal outcomes, but methotrexate does not serve this purpose.

B. Abruptio placentae. Methotrexate is not indicated for abruptio placentae, which is the premature separation of the placenta from the uterine wall. Management of abruptio placentae focuses on stabilizing the mother, monitoring fetal well-being, and delivering the baby if necessary.

C. Pre-eclampsia. Methotrexate does not treat pre-eclampsia. The management of pre-eclampsia includes antihypertensive medications, magnesium sulfate for seizure prevention, and delivery of the baby when indicated.

D. Unruptured ectopic pregnancy. Methotrexate is the first-line treatment for an unruptured ectopic pregnancy. It works by inhibiting rapidly dividing trophoblastic cells, stopping the growth of the ectopic pregnancy while preserving the fallopian tube. It is only used in stable patients with small, unruptured ectopic pregnancies and no signs of internal bleeding.

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A woman with a history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary health care practitioner?

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