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

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• The client is exhibiting classic symptoms of supine hypotensive syndrome, caused by the gravid uterus compressing the inferior vena cava when she is lying on her back.
• This compression reduces blood return to the heart, leading to decreased cardiac output, hypotension, and symptoms like dizziness and pallor.
• The immediate and highest priority nursing intervention is to relieve this compression by changing the client's position.
• Helping the client to a sitting position causes the uterus to shift forward, immediately taking pressure off the vena cava and restoring normal blood flow.

Why Other Options Were Wrong

• Option A: This position can worsen the compression by causing the uterus to shift upwards against the diaphragm and great vessels.
• Option B: The symptoms are specific to positional hypotension, not hemorrhage. This assessment delays the critical intervention of repositioning.
• Option C: This is an assessment, not an intervention. The question asks for the first intervention. The cause is clear, and action is needed before further assessment.

Related Visual

• Visual 1: Diagram: Illustration comparing the supine and left lateral positions in a pregnant woman, showing the compression of the inferior vena cava in the supine position and its relief in the lateral position.
• Visual 2: Flowchart: Step-by-step nursing response to suspected supine hypotensive syndrome, starting with repositioning, followed by vital signs assessment, and then further evaluation.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Management of Supine Hypotensive Syndrome in Pregnancy to guide bedside assessment, documentation, and the next nursing action.
• Nurses must educate all pregnant clients in their second and third trimesters to avoid lying flat on their back and to use a side-lying position or place a wedge under their hip for rest.
• This principle is critical during all clinical examinations, labor, transport, and any surgical or diagnostic procedures to ensure maternal and fetal well-being.
• What if? If the client was unable to sit up (e.g., during surgery with spinal anesthesia), 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 create a left lateral tilt.

How to Approach the Question

• First, identify the key elements of the scenario: a pregnant client, a supine position, and acute symptoms of hypotension (light-headed, pallor, sweating).
• Recognize this classic presentation as supine hypotensive syndrome (vena caval compression).
• The question asks for the 'first intervention.' This requires an action that solves the problem, not just an assessment step.
• Analyze the options to find the action that directly and immediately corrects the underlying cause.
• Option D (sitting position) and turning to the side are the only interventions that relieve the uterine pressure on the vena cava.
• Eliminate the other options: Trendelenburg is contraindicated, and assessing for bleeding or taking vitals are not the first intervention to fix the problem.

Concept Tested & Keywords

• Concept Tested: Management of Supine Hypotensive Syndrome in Pregnancy
• Stem keywords: pregnant client, lying supine, light-headed, pallor, perspiring
• Lead-in keywords: first intervention
• Clinical cues: Lying supine: This position is the direct cause of vena caval compression in late pregnancy.
• Clinical cues: Light-headedness, pallor, sweating: These are classic signs of decreased cardiac output and hypotension.

Question ID

Q6avmbuvTMHcqXatrFdrj3

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