# A nurse is caring for a pregnant client at 20 weeks gestation who has been diagnosed with cervical incompetence. Which nursing intervention is the priority for this client? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542916 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is caring for a pregnant client at 20 weeks gestation who has been diagnosed with cervical incompetence. Which nursing intervention is the priority for this client? ## 보기 1. Maintain strict bed rest with bathroom privileges only **✔ 정답** 2. Encourage frequent ambulation to promote circulation 3. Position the client in high Fowler's position during rest 4. Perform daily cervical examinations to monitor dilation **정답: 1** ## 해설 Strict bed rest with bathroom privileges only is the priority to reduce pressure on the incompetent cervix and prevent further dilation. Other options like ambulation, high Fowler's position, or frequent cervical exams could increase cervical stress or risk of infection. ## 심화 해설 Understanding Cervical Incompetence At 20 weeks gestation, the diagnosis of cervical incompetence indicates that the cervix is beginning to efface and dilate prematurely without the presence of regular uterine contractions. This structural weakness means the cervix can no longer support the weight of the growing pregnancy, which places the fetal membranes at high risk for prolapse and rupture. The pathophysiology involves a failure of the connective tissue integrity at the internal os, leading to painless cervical dilation and, if unmanaged, recurrent second-trimester loss or preterm birth [1]. The primary clinical goal is to remove gravitational pressure from the incompetent cervix and prevent mechanical stimulation of the lower uterine segment. Priority Intervention Analysis The priority nursing intervention is to maintain strict bed rest, often with bathroom privileges only, to minimize hydrostatic pressure on the cervix. In the context of cervical incompetence, the upright position directs the weight of the amniotic fluid, fetal parts, and uterine contents directly onto the internal os. By placing the client in a recumbent or lateral position, the force vector is redistributed along the long axis of the uterus, reducing the risk of further cervical shortening and membrane herniation. This conservative measure is a cornerstone of expectant management while awaiting definitive surgical intervention, such as cerclage placement [2]. The rationale is purely mechanical: reducing the downward force helps preserve the fragile barrier until a rescue cerclage can be considered to provide external mechanical support [3]. Analysis of Incorrect Options - Encouraging frequent ambulation is contraindicated. Ambulation increases gravitational force and intra-abdominal pressure, which directly counteracts the goal of offloading the cervix and can accelerate the process of dilation and membrane prolapse. - Positioning the client in high Fowler's position is incorrect because this upright, seated posture concentrates pressure on the lower uterine segment and cervix, mimicking the effects of standing and worsening the mechanical disadvantage of an incompetent cervix. - Performing daily cervical examinations is a harmful intervention. In suspected or confirmed cervical incompetence, digital examinations must be minimized or avoided entirely because they can introduce infection, stimulate the release of prostaglandins, and inadvertently rupture the bulging fetal membranes. Assessment relies on sterile speculum visualization and transvaginal ultrasound, not routine digital checks [1]. Clinical Decision-Making and Surgical Correlation The decision to prioritize bed rest is part of the expectant management pathway, which is often a bridge to surgical intervention. Cervical cerclage, the placement of a suture to mechanically reinforce the cervix, is the definitive treatment for cervical incompetence, with both history-indicated and ultrasound-indicated approaches showing benefit in prolonging gestation [2]. A rescue cerclage is performed when the cervix is already dilated and membranes may be visible, and its success is highly dependent on the absence of infection, contractions, and further mechanical trauma before the procedure [3]. Even in complex cases, such as after a failed transvaginal cerclage, the principle of preoperative stabilization through activity restriction remains critical to optimize the surgical field and reduce tension on the tissues before a transabdominal approach is attempted [4]. The nursing priority of strict bed rest directly supports these surgical goals by maintaining a quiescent, low-pressure environment. ## 임상 시나리오 Clinical Management: Cervical Incompetence A 28-year-old gravida 3, para 0 at 20 weeks gestation presents with a history of two prior second-trimester losses. Ultrasound reveals a shortened cervix with funneling at the internal os. The patient is diagnosed with cervical incompetence and admitted for expectant management prior to cerclage placement. Priority Nursing Intervention The immediate priority is to offload pressure from the incompetent cervix. The nurse should place the patient on strict bed rest in a lateral or Trendelenburg position. Bathroom privileges may be allowed with assistance, but the patient must avoid sitting upright or standing for prolonged periods. The rationale is to redirect the gravitational force vector away from the internal os, minimizing the risk of membrane prolapse or preterm premature rupture of membranes (PPROM). Key Contraindications - **Avoid Ambulation:** Walking or frequent movement increases hydrostatic pressure on the cervix. - **Avoid Upright Positioning:** High Fowler's or sitting positions concentrate fetal and fluid weight directly on the weakened internal os. - **Limit Vaginal Examinations:** Digital cervical checks are minimized to prevent mechanical irritation and infection risk unless signs of active labor or rupture are present. Ongoing Monitoring Monitor for signs of preterm labor, including regular contractions, pelvic pressure, or changes in vaginal discharge. Assess for leakage of fluid suggesting PPROM. Prepare the patient physically and emotionally for a McDonald or Shirodkar cerclage, typically performed between 12 and 24 weeks gestation, while maintaining strict activity restrictions to optimize surgical candidacy. ## 핵심 개념 - **Cervical Incompetence** — A condition characterized by painless dilation and effacement of the cervix in the second trimester, often leading to recurrent pregnancy loss or preterm birth due to structural weakness of the internal os. - **Cerclage** — A surgical procedure involving the placement of a suture around the cervix to provide mechanical support and prevent premature dilation in cases of cervical incompetence. - **Internal Os** — The internal opening of the cervix that connects the uterine cavity to the cervical canal; its integrity is crucial for maintaining pregnancy. - **Effacement** — The thinning and shortening of the cervix measured in percentages, occurring normally before labor but pathologically early in cervical incompetence. - **Hydrostatic Pressure** — The pressure exerted by the amniotic fluid and fetal parts against the cervix, which increases with upright maternal posture and can exacerbate cervical dilation. ## 같은 주제 문제 - [A nurse is assessing a 28-year-old gravida 2, para 1 pregnant client at 20 weeks gestation…](https://mymerci.kr/pages/nclex_q.php?qn_id=542913) - [A nurse is assessing a pregnant client at 20 weeks gestation who has a history of incompet…](https://mymerci.kr/pages/nclex_q.php?qn_id=542914) - [A nurse is assessing a 32-year-old gravida 3, para 2 pregnant client at 22 weeks gestation…](https://mymerci.kr/pages/nclex_q.php?qn_id=542915) - [A pregnant client at 18 weeks gestation is diagnosed with cervical incompetence and is sch…](https://mymerci.kr/pages/nclex_q.php?qn_id=542917) - [A pregnant client at 22 weeks gestation is diagnosed with cervical incompetence and is sch…](https://mymerci.kr/pages/nclex_q.php?qn_id=542918) - [A pregnant client at 20 weeks gestation is diagnosed with cervical incompetence and is sch…](https://mymerci.kr/pages/nclex_q.php?qn_id=542919) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._