Share This Link

Rationale for correct choices

• Hydatidiform mole: The client’s findings are consistent with a molar pregnancy. Key indicators include an intrauterine mass with cystic vesicles on ultrasound, absence of a fetus, elevated fundal height (28 cm at approximately 4 months gestation), and symptoms such as nausea/vomiting and dark brown vaginal discharge. Elevated blood pressure and anemia further support this diagnosis due to trophoblastic disease.
• Prepare the client for suction curettage: Suction curettage (D&C) is the primary treatment to evacuate abnormal trophoblastic tissue from the uterus. It helps prevent complications such as hemorrhage and progression to gestational trophoblastic neoplasia.
• Discuss weekly pregnancy hormone level monitoring: Serial monitoring of human chorionic gonadotropin (hCG) levels is essential to ensure complete resolution of trophoblastic tissue and to detect persistent disease or malignancy early.
• Vaginal bleeding: Bleeding is a common complication due to abnormal placental tissue and uterine evacuation. Monitoring helps detect hemorrhage or retained products.
• Blood pressure: Hypertension can occur with molar pregnancy due to excessive hCG levels and trophoblastic proliferation; monitoring helps detect complications such as preeclampsia-like symptoms.

Rationale for incorrect choices

• Ectopic pregnancy: This typically presents with unilateral pelvic pain and absence of intrauterine pregnancy on ultrasound, not a uterine mass with cystic vesicles.
• Abruptio placentae: Would present with painful vaginal bleeding and a tender, rigid uterus in later pregnancy, not cystic vesicles or absent fetus.
• Placenta previa: Characterized by painless bright red bleeding and a low-lying placenta, not uterine mass or elevated fundal height discrepancies.
• Prepare the client for an emergency cesarean birth: There is no viable fetus present, and ultrasound confirms absence of fetal structures.
• Administer terbutaline: Used for uterine relaxation in preterm labor, which is not applicable here.
• Cervical dilation: Not a key indicator in molar pregnancy; cervix is not the primary focus of pathology.
• Uterus for hypertonicity: Not typical; the uterus may be enlarged but not characteristically hypertonic.
• Unilateral pelvic pain: More consistent with ectopic pregnancy, not molar pregnancy.

• Apply warm compresses to eyes (Unanticipated): This intervention has no role in managing a pituitary adenoma or increased intracranial pressure (ICP). Eye compresses may be used for localized ocular conditions (e.g., stye, conjunctivitis), not neurological or intracranial pathology.
• Implement seizure precautions (Anticipated): A pituitary adenoma with neurologic symptoms (confusion, restlessness, headache, vomiting) suggests possible increased ICP or brain irritation. These conditions increase seizure risk, so seizure precautions (padding side rails, suction setup, airway protection) are appropriate.
• Administer furosemide (Anticipated): Furosemide is a loop diuretic that can help reduce intracranial pressure by decreasing cerebral edema and fluid volume. It is appropriate in suspected ICP elevation.
• Administer 0.9% sodium chloride 1000 mL IV at 150 mL/hr (Unanticipated): Large-volume isotonic fluid administration may worsen cerebral edema and increase ICP. In patients with suspected elevated ICP, fluid management must be cautious to avoid exacerbation of brain swelling.
• Administer dexamethasone (Anticipated): Dexamethasone is a corticosteroid that reduces cerebral edema and is commonly used in pituitary tumors or brain masses to decrease inflammation and ICP-related symptoms.

Rationale for correct choices

• Dry mouth (HEENT): Amitriptyline blocks muscarinic (acetylcholine) receptors, leading to decreased salivary gland secretion. This results in xerostomia (dry mouth), which can increase risk for dental caries, oral infections, and difficulty swallowing. Patients should be taught to increase fluid intake, chew sugarless gum, or use saliva substitutes.
• Tachycardia (Cardiovascular): TCAs inhibit norepinephrine reuptake and also have anticholinergic effects, both of which can increase heart rate. Additionally, TCAs can affect cardiac conduction (prolonged PR, QRS, QT intervals), making tachycardia and dysrhythmias important adverse effects to monitor, especially in older adults or those with cardiac disease.
• Urinary retention (Genitourinary): Anticholinergic effects reduce detrusor muscle contraction in the bladder, making it difficult to initiate urination and fully empty the bladder. This can lead to bladder distention and discomfort, particularly in older adults or those with prostate enlargement.
• Constipation (Gastrointestinal): TCAs decrease gastrointestinal motility due to their anticholinergic properties. This slows peristalsis, leading to constipation. Patients should be encouraged to increase fiber intake, fluid intake, and physical activity to prevent complications like fecal impaction.

Rationale for incorrect choices:

• Double vision: Although TCAs can cause blurred vision due to anticholinergic effects, dry mouth is a more common and expected finding emphasized in teaching.
• Sore throat: Not associated with TCA use; may indicate infection rather than medication effect.
• Chest pain: Not a typical expected side effect; could indicate a serious cardiac issue and requires immediate evaluation.
• Hypertension: TCAs are more likely to cause orthostatic hypotension due to alpha-1 blockade, not hypertension.
• Hematuria: No mechanism linking TCAs to blood in urine.
• Urinary incontinence: Opposite of expected effect; TCAs cause retention, not leakage.
• Weight loss: TCAs often cause weight gain due to increased appetite and metabolic effects.
• Diarrhea: Due to decreased GI motility, constipation—not diarrhea—is expected.