What is the primary management strategy for supine hypotensive syndrome?
Elevating the client's legs
Administering intravenous fluids
Turning the client to a side-lying position
Encouraging the client to lie flat on her back
The Correct Answer is C
Supine hypotensive syndrome occurs in late pregnancy due to compression of the inferior vena cava, decreased venous return, and reduced cardiac output when the woman lies flat on her back. Normally, venous return maintains stroke volume and cardiac output at 4.5–6.5 L/min in pregnancy, but vena caval obstruction can decrease cardiac output by up to 25–30%. Symptoms include dizziness, pallor, hypotension (systolic <100 mmHg), tachycardia, and nausea. The condition is relieved by positional changes that restore venous return.
Rationale for correct answers
3. Turning the client to a side-lying position, preferably left lateral, relieves pressure on the inferior vena cava and restores venous return, cardiac output, and blood pressure. This is the primary and most immediate management strategy.
Rationale for incorrect answers
1. Elevating the legs may slightly improve venous return but does not resolve vena cava compression if the woman remains supine. It is not the primary management.
2. Administering intravenous fluids does not address the mechanical obstruction caused by the gravid uterus. Fluids may support blood volume but cannot restore venous return while the vena cava is compressed.
4. Encouraging the client to lie flat on her back worsens the condition, as the gravid uterus continues to obstruct vena caval flow, further decreasing cardiac output and exacerbating hypotension.
Take home points
- Supine hypotensive syndrome is due to inferior vena cava compression by the gravid uterus.
- Primary management is left lateral positioning to relieve pressure and restore venous return.
- IV fluids and leg elevation are supportive but ineffective without position change.
- Differentiate from hypovolemic shock, where hypotension is due to blood loss, not vena caval compression.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C"]
Explanation
Management of pregnancy discomfortsrelies on distinguishing physiological changesfrom signs of pathology, prioritizing non-pharmacological interventions, and setting realistic expectationsfor symptom progression. Normal discomforts arise from hormonal changes, mechanical uterine pressure, and metabolic adjustments, while pathological symptoms (e.g., hypertension ≥140/90 mmHg, proteinuria >300 mg/24h, vaginal bleeding) indicate complications. Nursing practice emphasizes safe symptom relief, patient education, and timely recognition of danger signs.
Rationale for correct answers
1.Differentiating between normal discomforts and warning signs ensures early recognition of conditions like preeclampsia, preterm labor, or gestational diabetes, preventing complications.
2.Emphasizing non-pharmacological interventions first (e.g., position changes, hydration, diet, exercise) minimizes fetal exposure to medications and provides safe symptom relief.
3.Providing realistic expectations helps patients cope with ongoing discomforts, such as backache, edema, or heartburn, and prevents unnecessary anxiety.
Rationale for incorrect answers
4.Encouraging self-diagnosis is unsafe because patients may misinterpret pathological symptoms (e.g., preeclampsia headache) as normal discomfort, delaying critical care.
5.Advising immediate hospitalization for any discomfort is unnecessary and impractical; most discomforts are benign and manageable at home unless accompanied by red-flag symptoms.
Take home points
- Nurses must differentiate physiological discomforts from pathological warning signs.
- Non-pharmacological management is first-line and safe in pregnancy.
- Patient education should set realistic expectations about persistent discomforts.
- Immediate medical attention is warranted only when red-flag symptoms appear.
Correct Answer is B
Explanation
Backache in pregnancyis mainly due to relaxin-induced ligament laxity, lumbar lordosis, and increased mechanical strainfrom fetal growth. Relaxin peaks in the first trimester and remains elevated, softening the pubic symphysis and sacroiliac joints to prepare for childbirth. This increased joint mobility reduces pelvic and spinal stability, predisposing to lumbosacral pain. Additionally, weight gain (11.5–16 kg normal for BMI 18.5–24.9) and shift of the center of gravity increase lordotic curvature, straining paraspinal muscles.
Rationale for correct answers
2.Relaxation of pelvic ligaments and joints due to relaxin decreases pelvic stability, contributing to lumbosacral and back pain in pregnancy. This hormonal effect, combined with postural changes, explains the musculoskeletal discomfort commonly reported.
Rationale for incorrect answers
1.Lumbar lordosis actually increases, not decreases, in pregnancy due to the anterior shift in center of gravity. This worsens back strain but is not decreased as stated.
3.Reduced maternal weight gain would lessen, not worsen, back strain. It is excessive weight gain that increases musculoskeletal discomfort.
4.Abdominal muscle strength decreases as the uterus enlarges, further reducing core support. Increased strength would help prevent backache, not cause it.
Take home points
- Pregnancy backache results from relaxin-induced ligamentous laxity and increased lumbar lordosis.
- Mechanical load from fetal growth and maternal weight gain exacerbates pain.
- Reduced abdominal muscle tone worsens postural instability.
- Important differentials include urinary tract infection and preterm labor, which can also present with back pain.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.