The nurse is teaching a pregnant client about the morning sickness in pregnancy. Which of the following sign & symptom would indicate a need for further education?

Appeared in: SJH Nursing Officer - 2019

Explanation

Irregular and painless contractions are known as Braxton Hicks contractions, which are a normal physiological occurrence during the second and third trimesters of pregnancy.
When a client expresses concern about these normal contractions, it indicates a knowledge deficit and a misunderstanding of the typical changes that occur during pregnancy.
This misunderstanding signals a clear need for the nurse to provide further education to differentiate between normal discomforts and true danger signs, thereby reducing anxiety and ensuring the client knows when to seek actual medical help.

Option A: Visual disturbances are a serious danger sign, potentially indicating preeclampsia or eclampsia. A client reporting this needs immediate medical assessment, not just education about a misunderstanding.
Option B: Rapid weight gain is a key indicator of fluid retention and a potential sign of preeclampsia. This is a danger sign that warrants urgent medical evaluation.
Option C: Generalized or facial edema, particularly swelling of the hands and face, is a classic warning sign of preeclampsia. It requires prompt medical attention.

Clinical Relevance

Nursing practice connection: Use the key finding related to Differentiating between normal physiological changes and danger signs during pregnancy to guide bedside assessment, documentation, and the next nursing action.
A primary role of the nurse in antenatal care is to educate the client on how to distinguish between normal discomforts and true danger signs. This empowers the client to participate in her own care, reduces anxiety over normal changes, and ensures she seeks timely help for serious complications.
Failure to recognize and report danger signs like those of preeclampsia can lead to severe maternal and fetal morbidity, including seizures (eclampsia), organ damage, and even death.
What if? If the client reported irregular contractions accompanied by vaginal bleeding or a gush of fluid, the situation would change from a need for education to a potential emergency (e.g., preterm labor, placental abruption, or ruptured membranes), requiring immediate evaluation.

How to Approach the Question

First, identify the core question being asked. The prompt is not asking for a danger sign, but rather which symptom, if reported by the client, would indicate a need for further education.
Analyze each option to determine if it is a normal finding or a danger sign.
Options A, B, and C (visual disturbances, rapid weight gain, facial edema) are all well-known danger signs of preeclampsia.
Option D (irregular, painless contractions) describes Braxton Hicks contractions, which are a normal part of pregnancy.
Reason through the clinical scenario: If a client reports a true danger sign (A, B, or C), she is correctly identifying a problem and needs urgent medical care. This demonstrates understanding, not a knowledge deficit.
Conversely, if a client reports a normal finding (D) as a concern, it reveals a misunderstanding of her body's normal processes during pregnancy. This is a direct indication that further teaching is necessary.

Concept Tested & Keywords

Concept Tested: Differentiating between normal physiological changes and danger signs during pregnancy.
Stem keywords: pregnant client, teaching, morning sickness, sign & symptom
Lead-in keywords: need for further education
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 7-12

E6 Obstetrics Williams p. 2-9

E6 Parks TextBook of Preventive & Social Medicine part 2 — Subpart A (pp 1-232 of 464) p. 19-21

Practise the full SJH Nursing Officer - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.