A nurse is assessing a 52-year-old primigravida woman who ...

[ENagel]

A nurse is assessing a 52-year-old primigravida woman who presents complaining of moderate dark-brown vaginal bleeding. On physical exam, her uterus is large for dates. Which action by the nurse is most appropriate?
 
  A.
  Assess the woman's diet for folic acid intake.
  B.
  Facilitate an ultrasound examination.
  C.
  Instruct the woman on a fetal kick count.
  D.
  Prepare the woman for pelvic cultures.

Question 2

A nurse is caring for a patient who has been diagnosed with an incomplete molar pregnancy. Which action by the nurse is most appropriate?
 
  A.
  Advise the woman that she can try to get pregnant in 3 months.
  B.
  Arrange a consultation with a radiation oncology nurse.
  C.
  Facilitate screening for systemic lupus erythematosus (SLE).
  D.
  Give the patient information on perinatal loss support groups.

[mistyjohnson]

Answer to Question 1

ANS: B
The incidence of gestational trophoblastic disease (GTD), including hydatidiform mole, increases in women of advanced age (especially over 50). Dark-brown vaginal bleeding is one symptom of this condition, and the nurse should be cognizant of its possibility. Because hydatidiform mole is diagnosed with ultrasound, the nurse should facilitate this testing. A diet low in folic acid is a risk factor, but the nurse should delay assessing for risk factors until after he or she has facilitated the ultrasound. Because molar pregnancies are either associated with no fetus or one that is generally spontaneously aborted, instructing the woman on fetal kick counts is not appropriate. The patient does not need pelvic cultures for this condition.

Answer to Question 2

ANS: D
Gestational trophoblastic disease (GTD) is a disease characterized by an abnormal placental development that results in the production of fluid-filled grapelike clusters (instead of normal placental tissue) and a vast proliferation of trophoblastic tissue. GTD includes the diagnosis of hydatidiform mole (molar pregnancy). Complete moles have a proliferation of trophoblastic tissue, but no fetal parts. An incomplete mole is associated with a coexistent fetus that is genetically abnormal and usually only survives a few weeks before being spontaneously aborted. Support groups for grieving parents are an important community resource, and the nurse should ensure that the woman has information on local organizations. Management includes emptying the uterus of its contents with strict follow-up. Women should not become pregnant for at least a year afterward. Incomplete moles are almost always benign, so a consultation for a radiation oncology nurse is most likely not needed. Screening for SLE is done in women who have habitual abortions.

[ENagel]

Gracias!

[Joy Chen]

Thanks for the timely response, appreciate it