A nurse is caring for a client who has a suspected ectopic pregnancy at 8 weeks of gestation. Which of the following manifestations should the nurse expect to identify as consistent with the diagnosis?
Large amount of vaginal bleeding
Uterine enlargement greater than expected for gestational age
Severe nausea and vomiting
Unilateral, cramp-like abdominal pain
The Correct Answer is D
Choice A reason:
A large amount of vaginal bleeding is not typically associated with an ectopic pregnancy. While some vaginal bleeding can occur, it is usually light and not the primary symptom. Heavy bleeding is more commonly associated with other complications such as miscarriage or placental issues.
Choice B reason:
Uterine enlargement greater than expected for gestational age is not a characteristic of ectopic pregnancy. In fact, the uterus may not enlarge significantly because the pregnancy is occurring outside the uterine cavity. This symptom is more indicative of conditions like molar pregnancy.
Choice C reason:
Severe nausea and vomiting are common symptoms of a normal pregnancy due to hormonal changes but are not specific to ectopic pregnancy. While some women with ectopic pregnancies may experience nausea and vomiting, these symptoms alone are not diagnostic.
Choice D reason:
Unilateral, cramp-like abdominal pain is a hallmark symptom of ectopic pregnancy. This pain typically occurs on one side of the abdomen, corresponding to the location of the ectopic implantation, usually in a fallopian tube. The pain can become severe and is often accompanied by light vaginal bleeding. If the fallopian tube ruptures, the pain can become intense and may be accompanied by signs of internal bleeding, such as dizziness, shoulder pain, and shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
The primary reason for performing an ultrasound before an amniocentesis is to identify the location of the placenta and fetus. This ensures that the needle used for the procedure can be safely inserted into the amniotic sac without harming the fetus or placenta12. The ultrasound helps guide the healthcare provider to a safe location for the needle insertion, minimizing risks associated with the procedure.
Choice B Reason:
While an ultrasound can be useful for estimating fetal age, this is not the primary reason for performing it before an amniocentesis. The main goal is to ensure the safety of the procedure by accurately locating the fetus and placenta.
Choice C Reason:
An ultrasound is not primarily a screening tool for spina bifida. Although it can help detect certain congenital anomalies, the main purpose of the ultrasound before an amniocentesis is to guide the needle insertion safely.
Choice D Reason:
Determining if there is more than one fetus can be an incidental finding during an ultrasound, but it is not the primary reason for performing the ultrasound before an amniocentesis. The main objective is to ensure the safe placement of the needle by identifying the exact location of the fetus and placenta.
Correct Answer is C
Explanation
Choice A Reason:
Allowing the grandmother to push the baby to the room in a wheeled bassinet is not advisable. Hospitals have strict protocols to prevent infant abduction, and only authorized personnel should transport newborns. This ensures the safety and security of the infant.
Choice B Reason:
Requiring photo identification from the grandmother before allowing her to take the infant is not a standard practice. While identification is crucial, it is typically the responsibility of the hospital staff to transport the newborn to ensure proper security measures are followed.
Choice C Reason:
Having the mother call and the nurse taking the baby to the room is the most appropriate response. This ensures that the newborn is transported safely by authorized personnel, adhering to hospital protocols designed to prevent infant abduction and ensure the baby’s safety.
Choice D Reason:
Allowing the grandmother to carry the grandchild to the room is not recommended. Similar to choice A, this does not align with hospital security protocols. Only authorized personnel should handle the transportation of newborns within the hospital to maintain safety and security.
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