A nurse in a prenatal clinic is caring for a client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client?
Rapid decline in human chorionic gonadotropin (hCG) levels
Irregular fetal heart rate
Excessive uterine enlargement
Profuse, clear vaginal discharge
The Correct Answer is C
Choice A Reason:
A rapid decline in human chorionic gonadotropin (hCG) levels is not typically associated with a hydatidiform mole. In fact, hCG levels are usually elevated in cases of hydatidiform mole due to the abnormal growth of trophoblastic tissue. Elevated hCG levels can lead to symptoms such as severe nausea and vomiting, which are more indicative of this condition.
Choice B Reason:
An irregular fetal heart rate is not a common finding in hydatidiform mole cases. In a complete molar pregnancy, there is no viable fetus, and therefore, no fetal heart rate can be detected. In partial molar pregnancies, there may be some fetal tissue, but it is typically not viable and does not develop a regular heart rate.
Choice C Reason:
Excessive uterine enlargement is a hallmark sign of a hydatidiform mole. This condition causes the uterus to grow more rapidly than it would in a normal pregnancy due to the abnormal proliferation of trophoblastic tissue. This rapid growth can lead to a uterus that is significantly larger than expected for the gestational age.
Choice D Reason:
Profuse, clear vaginal discharge is not specifically associated with hydatidiform mole. While vaginal discharge can increase during pregnancy, the discharge associated with a molar pregnancy is typically dark brown or red due to bleeding from the abnormal tissue. Clear discharge is more commonly associated with normal pregnancy changes or other conditions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Drying the newborn’s skin thoroughly is the most effective way to reduce evaporative heat loss. When a newborn is born, they are wet with amniotic fluid, which can evaporate and cool the skin rapidly. By drying the infant thoroughly, the nurse removes this moisture, thereby preventing heat loss through evaporation.
Choice B Reason:
Preventing air drafts is important for reducing convective heat loss, not evaporative heat loss. Convective heat loss occurs when cool air moves across the skin, taking heat away from the body. While preventing drafts is crucial, it does not directly address evaporative heat loss.
Choice C Reason:
Placing the newborn on a warm surface helps reduce conductive heat loss, which occurs when the baby comes into contact with a cooler surface. While this is an important step in maintaining the newborn’s temperature, it does not specifically address evaporative heat loss
Choice D Reason:
Maintaining an ambient room temperature at 24°C (75.2°F) helps create a warm environment for the newborn, reducing overall heat loss. However, this action primarily addresses convective and radiant heat loss rather than evaporative heat loss.
Correct Answer is D
Explanation
Choice A reason:
Inwardly turned foot on the affected side: An inwardly turned foot, also known as metatarsus adductus, is not typically associated with developmental dysplasia of the hip (DDH). This condition is more related to foot positioning and alignment rather than hip dysplasia.
Choice B reason:
Absent plantar reflexes: The plantar reflex, also known as the Babinski reflex, is usually present in newborns and indicates normal neurological function. An absent plantar reflex is not a common finding in DDH and would more likely suggest a neurological issue.
Choice C reason:
Lengthened thigh on the affected side: In DDH, the affected thigh is often shorter, not longer, due to the displacement of the femoral head from the acetabulum. This can lead to a noticeable difference in leg length.
Choice D reason:
Asymmetric thigh folds: Asymmetric thigh folds are a common sign of DDH. When the hip is dislocated or subluxated, it can cause uneven skin folds on the thighs and buttocks. This asymmetry is a key indicator that prompts further investigation, such as an ultrasound or X-ray.
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