A pregnant woman complains of heartburn during her third trimester. Which combination of management strategie… - RRB Nsg. Superintendent-2026 (Shift -3rd)

RRB Nsg. Superintendent-2026 (Shift -3rd)

Obstetrics & Gynaecology

Hard

Appeared in: RRB Nsg. Superintendent-2026 (Shift -3rd)

Explanation

Heartburn in pregnancy is caused by the relaxation of the lower esophageal sphincter (LES) due to progesterone and pressure from the enlarging uterus.
Eating small, frequent meals prevents the stomach from becoming overly full, which reduces upward pressure on the LES.
Avoiding spicy and fatty foods decreases gastric acid production and irritation of the esophagus, which can trigger heartburn symptoms.
This combination of dietary and behavioral modifications directly targets the physiological causes of heartburn, making it the most effective and safest initial approach.

Option A: Skipping meals can lead to excessive hunger and overeating later, worsening reflux. Caffeine is a known trigger for heartburn as it further relaxes the lower esophageal sphincter and can increase stomach acid.
Option B: Carbonated beverages increase gas in the stomach, leading to bloating and increased intragastric pressure, which promotes the reflux of acid into the esophagus.
Option D: Eating large meals overfills the stomach, increasing pressure on the lower esophageal sphincter. Lying down immediately after eating removes the effect of gravity, making it much easier for stomach acid to flow back into the esophagus.

Visual 1: Diagram - An illustration showing a pregnant woman in the third trimester. One side shows the enlarged uterus pressing on the stomach and a relaxed lower esophageal sphincter, with an arrow indicating acid reflux. The other side shows the effect of sitting upright and having a smaller meal, with less pressure and no reflux.
Visual 2: Infographic - A list of 'Do's and Don'ts' for managing heartburn in pregnancy. 'Do's' would include eating small meals, staying upright, and wearing loose clothes. 'Don'ts' would include eating spicy/fatty foods, drinking carbonated drinks, and lying down after meals.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of minor disorders during pregnancy (Heartburn/Pyrosis) as background academic context rather than a clinical decision trigger.
Patient education is a key nursing role. Nurses must be able to provide clear, evidence-based advice on managing common discomforts of pregnancy like heartburn to improve the patient's quality of life.
Understanding these non-pharmacological strategies is the first line of defense, promoting patient self-management and reducing the need for medication.
What if? If a patient's heartburn does not improve with these lifestyle and dietary changes, the next step would be to consider over-the-counter antacids (like those containing calcium carbonate, aluminum hydroxide, or magnesium hydroxide) after consultation with her healthcare provider. If symptoms persist, further evaluation for more severe GERD might be necessary.

How to Approach the Question

First, identify the core clinical problem: heartburn in a third-trimester pregnant woman.
Recall the physiological changes in pregnancy that cause heartburn: hormonal relaxation of the lower esophageal sphincter (LES) and physical pressure from the growing uterus on the stomach.
Evaluate each option based on how it would affect these physiological factors.
Option A (skipping meals, caffeine): Recognize that caffeine relaxes the LES, worsening the problem. Skipping meals is also counterproductive.
Option B (carbonated drinks): Understand that carbonation increases stomach pressure, which would force acid upward.
Option D (large meals, lying down): Identify that both actions directly counteract the goals of managing reflux. Large meals increase stomach volume, and lying down eliminates gravity's help.

Concept Tested & Keywords

Concept Tested: Management of minor disorders during pregnancy (Heartburn/Pyrosis)
Stem keywords: pregnant woman, heartburn, third trimester, management strategies
Lead-in keywords: most appropriate
Clinical cues: Third trimester pregnancy, which is when heartburn is most common due to the size of the uterus and peak progesterone levels.

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