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 A

Explanation

A. Request the client to empty her bladder is the correct action. A fundus that is firm but deviated to the left and higher than expected (U+1) suggests that the bladder is full. A full bladder can displace the uterus, causing it to become misaligned and elevated. Asking the client to empty her bladder is often the first step to address this situation before proceeding with further assessment or intervention.

B. Follow PRN order to insert a straight urinary catheterization might be appropriate if the client is unable to empty her bladder voluntarily, but it is typically a last resort. Before resorting to catheterization, encourage the client to try to void first.

C. Start an IV and add 20 units Pitocin would be indicated if there were signs of uterine atony or hemorrhage. However, in this case, the issue seems related to bladder distention rather than uterine atony, so starting Pitocin is not the appropriate immediate response.

D. Massage fundus until it descends below the level of the umbilicus would be done if the fundus were boggy or soft, indicating uterine atony. However, in this case, the fundus is described as firm, so massaging is not necessary. The priority is addressing the bladder distention.

A. using a radiant warmer to transport a newborn B. placing a cap on a newborn's head C. placing the newborn skin-to-skin with the mother D. closing doors and windows to prevent draft

Correct Answer is D

Explanation

A. Using a radiant warmer to transport a newborn helps prevent radiant heat loss, not convection. Radiant heat loss occurs when heat transfers from the newborn to cooler surfaces not in direct contact, such as walls or windows.
B. Placing a cap on a newborn's head is effective in reducing evaporative and radiant heat loss from the head, but it does not specifically address heat loss through air movement (convection).
C. Placing the newborn skin-to-skin with the mother reduces conductive heat loss by providing a warm surface (the mother's skin), not convection.
D. Closing doors and windows to prevent draft helps reduce convective heat loss, which occurs when air currents pass over the newborn's skin and carry away body heat. Eliminating drafts minimizes this form of heat loss, making this the correct intervention for convection.

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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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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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