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 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.

A. Polyhydramnios B. Placenta previa C. Placental abruption D. Ruptured ectopic pregnancy

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.

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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 D

Explanation

Correct Answer is B

Explanation

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