A pregnant client continues to visit the clinic regularly during her pregnancy. During one of her visits while lying supine on the examining table, she tells the RN that she is becoming light-headed. The RN notices that the client has pallor in her face and is perspiring profusely. The first intervention the RN should initiate is to?

1. A

   Place the examining table in the Trendelenburg position

2. B

   Assess the client to see if she is having vaginal bleeding

3. C

   Obtain the client's vital signs immediately

4. D

   Help the client to a sitting position

Appeared in: NORCET 5 mains

Explanation

Listen in Hindi

• The client's symptoms (light-headedness, pallor, sweating) while lying supine are characteristic of supine hypotensive syndrome.
• This syndrome occurs when the weight of the gravid uterus compresses the inferior vena cava, obstructing blood return to the heart and causing a sudden drop in blood pressure.
• The immediate priority is to relieve this compression by changing the client's position.
• Helping the client to a sitting position or turning her onto her left side effectively displaces the uterus from the vena cava, restoring normal blood flow and resolving the symptoms.

Why Other Options Were Wrong

• Option A: Placing the client in the Trendelenburg position can worsen the condition by causing the gravid uterus to shift further superiorly, increasing pressure on the inferior vena cava and diaphragm.
• Option B: The symptoms presented are classic for positional hypotension, not hemorrhage. While assessing for bleeding is a standard part of prenatal care, it is not the priority intervention for resolving acute, position-related symptoms.
• Option C: Obtaining vital signs is an assessment, not an intervention. While it is important to do, the first action must be to correct the cause of the problem. Delaying the position change to take vital signs would prolong the hypotensive episode.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to The question tests the nurse's knowledge of the immediate management of supine hypotensive syndrome in a pregnant client to guide bedside assessment, documentation, and the next nursing action.
• Nurses must be able to rapidly identify supine hypotensive syndrome and intervene immediately by repositioning the client. Prolonged maternal hypotension can lead to decreased uteroplacental perfusion and fetal hypoxia.
• Patient education is a critical nursing responsibility. Pregnant women in their second and third trimesters should be advised to avoid lying flat on their backs and to use pillows or a wedge to maintain a side-lying (preferably left lateral) or semi-sitting position during rest or sleep.
• What if? If the client was unable to move herself (e.g., due to an epidural), the nurse's first action would be to manually displace the uterus to the left or place a wedge under the client's right hip to achieve a left uterine tilt.

How to Approach the Question

• First, analyze the clinical scenario presented. The key elements are: a pregnant client, a supine position, and the acute onset of specific symptoms (light-headedness, pallor, sweating).
• Recognize that this constellation of signs and symptoms points directly to a specific, common condition in pregnancy: supine hypotensive syndrome.
• Recall the underlying pathophysiology: the gravid uterus is compressing the inferior vena cava, obstructing blood flow back to the heart.
• The question asks for the 'first intervention'. This requires you to prioritize actions. The goal is to choose the action that will most quickly and directly resolve the root cause of the problem.
• Evaluate each option against this goal:
• Option A (Trendelenburg): Would this relieve the pressure? No, it could make it worse.

Concept Tested & Keywords

• Concept Tested: The question tests the nurse's knowledge of the immediate management of supine hypotensive syndrome in a pregnant client.
• Stem keywords: pregnant client, lying supine, light-headed, pallor, perspiring
• Lead-in keywords: first intervention
• Clinical cues: The combination of supine position and symptoms of hypotension (light-headedness, pallor) is a classic presentation of vena cava compression.
• Negative lead-in flag: false

Question ID

Q6avmbuvTMHcqXatrFdrj3

Copy ID

Reference Book

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 23-31