# A 25-year-old primigravida at 32 weeks gestation comes to the prenatal clinic complaining of severe heartburn that occurs daily, especially after meals and when lying down. She states that antacids provide only temporary relief. What is the most important assessment the nurse should perform first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542833  
> language: ko  
> subject: Maternal Newborn Health

## 문제

A 25-year-old primigravida at 32 weeks gestation comes to the prenatal clinic complaining of severe heartburn that occurs daily, especially after meals and when lying down. She states that antacids provide only temporary relief. What is the most important assessment the nurse should perform first?

## 보기

1. Assess the client's dietary habits and meal timing patterns **✔ 정답**
2. Evaluate the frequency and severity of nausea and vomiting
3. Check the client's weight gain pattern throughout pregnancy
4. Assess blood pressure and check for signs of preeclampsia

**정답: 1**

## 해설

Severe heartburn in pregnancy is commonly due to hormonal changes and mechanical pressure; dietary assessment is the priority initial evaluation. Preeclampsia assessment is not indicated for isolated heartburn without other symptoms.

## 심화 해설

Clinical Judgment
The core of this question is prioritization and identifying red flags. The patient is in the third trimester (32 weeks) and complains of heartburn, but the expressions "severe," "occurs daily," and "temporary relief with antacids" suggest the possibility of something more than simple gastroesophageal reflux disease (GERD). The nurse's first clinical judgment is to rule out the most dangerous possibility first. In this case, severe heartburn can be an atypical symptom of preeclampsia, specifically a sign of liver capsule distension (hepatic capsular stretch pain) associated with HELLP syndrome. Therefore, the most important initial assessment is to measure blood pressure and check for other signs of preeclampsia, such as headache, visual changes, epigastric/right upper quadrant tenderness, and edema.

Memory Tip:
**H**eartburn in the **3**rd trimester? **THINK Preeclampsia!**

**I**t's not just **G**ERD; it could be **H**ELLP.

KR vs US:
In Korea, education on hypertensive disorders of pregnancy is provided, but the recognition of heartburn as a 'red flag' symptom of preeclampsia may be relatively less emphasized. NGN/US nursing places great importance on the context of symptoms. The context of 'third trimester + severe/treatment-resistant heartburn' is a signal that should automatically switch to 'risk assessment' mode.

## 임상 시나리오

Clinical Practice Guide
When a third-trimester pregnant woman complains of severe heartburn:

1.  Immediately measure blood pressure and check if systolic is ≥140 mmHg or diastolic is ≥90 mmHg.

2.  Obtain a urine specimen for proteinuria testing.

3.  Ask, "Where exactly do you feel the heartburn?" and have her point to the location with her finger. Preeclampsia-related pain is often localized to the right upper quadrant (RUQ) or epigastric area.

4.  Concurrently assess for other symptoms such as headache, visual disturbances (blurring, spots), and severe edema (especially of the face/hands).

Caution:
In SATA (Select All That Apply) questions asking about "nursing actions for a third-trimester pregnant woman with severe heartburn," general GERD management such as "providing dietary advice" or "recommending head elevation" are actions that should be performed only after first ruling out dangerous complications. Choosing these general interventions without first assessing for preeclampsia is a common pitfall.

## 핵심 개념

- **Preeclampsia (자간전증)** — Hypertension (systolic ≥140 or diastolic ≥90 mmHg) and proteinuria (≥300mg/24 hours) or signs of other organ dysfunction occurring after 20 weeks of pregnancy, a pregnancy complication characterized by these features.
- **HELLP Syndrome (헬프 증후군)** — A severe form of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets. Severe right upper quadrant or epigastric pain may be the main symptom.
- **Gastroesophageal Reflux Disease (GERD) (위식도역류질환)** — The contents above flow back into the esophagus, causing symptoms such as heartburn (chest burning). During pregnancy, it commonly occurs due to relaxation of the lower esophageal sphincter caused by progesterone and pressure from the uterus.
- **Epigastric/Right Upper Quadrant Pain (상복부/우상복부 통증)** — Pain that can occur in preeclampsia, especially HELLP syndrome, due to stretching of the liver capsule or vasospasm. An important warning sign that can be mistaken for severe heartburn or indigestion.
- **Primigravida (초산부)** — A woman in her first pregnancy. This is one of the major risk factors for preeclampsia.

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