The nurse is giving discharge instructions to the client following evacuation of the molar pregnancy. Which of the following information should the nurse ascertain that the client understands?

Have her blood checked every month for the next 360 days.

Receive Rhogam with the next pregnancy

Seek genetic counselling with her partner before the next pregnancy

Becoming pregnant within the year

Answer and Explanation

The Correct Answer is A

A. Have her blood checked every month for the next 360 days is correct. After a molar pregnancy (also known as a hydatidiform mole), the client must have serial monitoring of hCG levels (usually monthly for 6 to 12 months) to ensure that all molar tissue has been removed and that gestational trophoblastic disease (such as choriocarcinoma) does not develop. A rising or persistently elevated hCG level can indicate malignancy.

B. Receive Rhogam with the next pregnancy may be necessary if the client is Rh-negative, but it is not specific or essential to the follow-up care for a molar pregnancy itself.

C. Seek genetic counselling with her partner before the next pregnancy is not routinely required after a molar pregnancy unless there’s a history of recurrent molar pregnancies or other genetic concerns.

D. Becoming pregnant within the year is discouraged. Pregnancy should be avoided for at least 6 to 12 months after molar pregnancy to allow for monitoring of hCG levels without interference from a new pregnancy, which could complicate interpretation of results.

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Correct Answer is B

Explanation

A. Polyhydramnios refers to an excessive amount of amniotic fluid and typically presents with maternal discomfort, dyspnea, and possibly preterm labor, but not with vaginal bleeding as a primary symptom.

B. Placenta previa is the most likely diagnosis based on the assessment findings. It typically presents with painless, bright red vaginal bleeding in the second or third trimester, a soft, nontender uterus, no contractions, and a normal fetal heart rate. The bleeding may start spontaneously and often recurs. This fits the client's clinical picture precisely.

C. Placental abruption usually involves painful vaginal bleeding, a firm or tender uterus, and may be associated with uterine contractions or abnormal fetal heart rate patterns. The absence of pain and uterine tenderness in this case makes placental abruption less likely.

D. Ruptured ectopic pregnancy would not be expected at 33 weeks’ gestation. Ectopic pregnancies typically present in the first trimester and are accompanied by severe abdominal pain, vaginal bleeding, and signs of hypovolemic shock if ruptured.

A. The client talks frequently about her labor and delivery B. The client hesitates to initiate contact with the baby C. The client questions the nurse about the amount of formula for baby D. The client request between meals snacks

Correct Answer is A

Explanation

A. The client talks frequently about her labor and delivery is a characteristic behavior of the Taking In phase, which occurs during the first few days postpartum. During this phase, the mother is primarily focused on her own needs and recovering from childbirth. She may want to discuss her labor and delivery experience and may be more focused on rest and reflection rather than engaging with the baby.

B. The client hesitates to initiate contact with the baby is more characteristic of the Taking Hold phase, which comes after the Taking In phase. In the Taking Hold phase, the mother begins to take more responsibility for her baby’s care, though she may still seek guidance.

C. The client questions the nurse about the amount of formula for the baby indicates a more active engagement in learning about infant care, which is typical of the Taking Hold phase, where the mother starts to focus on baby care and becomes more involved.

D. The client requests between meals snacks is a sign of physical recovery and possibly an increased need for nourishment, but it does not specifically indicate being in the Taking In phase. This behavior may occur in any phase but is not a defining characteristic.

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The nurse is giving discharge instructions to the client following evacuation of the molar pregnancy. Which of the following information should the nurse ascertain that the client understands?

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Correct Answer is B

Explanation

A nurse is providing care to a postpartum woman. Which of the following behavior by the client would indicate the client is in the Taking in phase?

Correct Answer is A

Explanation

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