A nurse is caring for a female client who is at 8 weeks of gestation in the emergency department.

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.

Answer and Explanation

The Correct Answer is []

Rationale for correct condition:
Ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, typically in the fallopian tube. The absence of an intrauterine pregnancy on transvaginal ultrasound at an hCG level of 2000 IU/L (above the discriminatory zone of 1500-2000 IU/L) strongly suggests ectopic pregnancy. The patient’s left lower quadrant pain and vaginal bleeding are classic signs. Progesterone >4 ng/dL indicates a potentially viable pregnancy, but no intrauterine gestation confirms ectopic risk. Early diagnosis is crucial to prevent tubal rupture and hemorrhagic shock.

Rationale for correct actions:
Intramuscular methotrexate is a folic acid antagonist used to medically manage unruptured ectopic pregnancies by inhibiting trophoblastic cell division. It is preferred when the patient is hemodynamically stable, avoiding surgery. CBC monitors for anemia from bleeding; liver function tests assess methotrexate toxicity risk, as the drug is hepatotoxic. Both are essential for safe medical management.

Rationale for correct parameters:
Hypotension indicates potential internal bleeding from tubal rupture requiring immediate intervention. Referred shoulder pain occurs from diaphragmatic irritation by blood in the peritoneal cavity, signaling intra-abdominal hemorrhage. Monitoring these signs allows early detection of complications.

Rationale for incorrect conditions:
Spontaneous abortion typically shows declining hCG and intrauterine findings of miscarriage, which are absent here. Molar pregnancy presents with markedly elevated hCG (>100,000 IU/L) and characteristic ultrasound “snowstorm” appearance, not seen. Cervical insufficiency causes painless cervical dilation in the second trimester, not early pregnancy pain with bleeding.

Rationale for incorrect actions:
Dilation and curettage is indicated in incomplete abortion, not ectopic pregnancy. Cervical cerclage treats cervical insufficiency, unrelated to this presentation. Oxytocic agents induce uterine contractions in miscarriage or labor, not ectopic management.

Rationale for incorrect parameters:
Size of uterus is irrelevant here because no intrauterine pregnancy is seen. Uterine cramping is nonspecific and more relevant in miscarriage. Leakage of amniotic fluid occurs in membrane rupture, not ectopic pregnancy.

Take-home points:

Absence of intrauterine pregnancy at hCG >1500 IU/L suggests ectopic pregnancy.
Methotrexate is first-line medical treatment for stable ectopic pregnancies.
Hypotension and referred shoulder pain are critical signs of rupture and hemorrhage.
Differentiation from miscarriage, molar pregnancy, and cervical insufficiency is vital for appropriate care.

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Correct Answer is C

Explanation

Choice A rationale

Feeding from the affected breast is crucial for promoting milk drainage and preventing milk stasis, which can exacerbate mastitis. Emptying the breast, even if painful, helps to clear the blocked ducts and reduce the bacterial load. Discontinuing feeding from the affected breast could lead to engorgement and worsening of the infection, hindering recovery.

Choice B rationale

Pumping and discarding milk is not recommended for mastitis. The milk from a breast with mastitis is generally safe for the infant, and the act of pumping helps to empty the breast and facilitate drainage, similar to direct breastfeeding. Discarding the milk unnecessarily deprives the infant of nutrition and can contribute to decreased milk supply.

Choice C rationale

Applying moist heat to the affected breast can significantly alleviate discomfort and promote milk flow by causing vasodilation and encouraging ductal patency. This helps to reduce inflammation, improve circulation, and facilitate the drainage of milk from the breast, which is essential for resolving the infection and reducing pain.

Choice D rationale

Maintaining adequate hydration is important for overall health, especially during lactation. However, a specific fluid intake of exactly 1,500 milliliters per day is not the primary or most effective intervention for mastitis. While hydration supports milk production, the core interventions for mastitis focus on milk drainage, pain management, and often antibiotic therapy.

A. Elevate the head of the client's bed 30 degrees. B. Administer a dose of terbutaline. C. Initiate oxygen at 2 L/min via nasal cannula. D. Initiate an infusion of oxytocin.

Correct Answer is ["C","D"]

Explanation

Choice C rationale

The client is tachycardic and has cool skin, indicating potential hypovolemia or shock due to excessive bleeding. Administering oxygen at 2 L/min via nasal cannula increases oxygen delivery to the tissues, improving cellular oxygenation and mitigating the effects of decreased circulating blood volume. This supports vital organ function and helps address tissue hypoxia, a common consequence of significant blood loss. Normal heart rate postpartum is 60-100 beats per minute.

Choice D rationale

Oxytocin is a uterotonic agent that stimulates uterine contractions. A boggy uterus and excessive bleeding are hallmark signs of uterine atony, the most common cause of postpartum hemorrhage. Initiating an infusion of oxytocin will promote uterine contraction, which compresses blood vessels and reduces blood loss, thereby addressing the underlying cause of the client's symptoms and preventing further hemorrhage. Normal lochia should be moderate in amount.

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Naxlex Comprehensive Predictor Exams

A nurse is providing teaching for a client who is 2 weeks postpartum and has mastitis. Which of the following instructions should the nurse include in the teaching?

Correct Answer is C

Explanation

A nurse is assessing a client who is 6 hours postpartum, tachycardic, and has cool skin. The client reports that they have been bleeding excessively. Which of the following actions should the nurse take?

Correct Answer is ["C","D"]

Explanation

A nurse is caring for a newborn immediately following birth. The newborn has meconium-stained amniotic fluid. Which of the following actions should the nurse take first?

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