# A pregnant client at 32 weeks gestation tests positive for COVID-19. Which assessment finding would be the priority concern for the nurse? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542924 > language: ko > subject: Maternal Newborn Health ## 문제 A pregnant client at 32 weeks gestation tests positive for COVID-19. Which assessment finding would be the priority concern for the nurse? The nurse is caring for a 30-year-old pregnant client at 32 weeks gestation who was recently diagnosed with COVID-19. The client presents to the obstetric unit for evaluation. ## 보기 1. Mild headache and fatigue 2. Oxygen saturation of 88% on room air **✔ 정답** 3. Loss of taste and smell 4. Low-grade fever of 100.2°F (37.9°C) **정답: 2** ## 해설 Oxygen saturation of 88% indicates severe hypoxemia, posing immediate risks to maternal and fetal well-being in COVID-19. Other options represent common but less critical symptoms manageable with supportive care. ## 심화 해설 Clinical Priority Analysis When a pregnant client presents with COVID-19, the nurse must apply the airway, breathing, and circulation (ABC) framework to identify the most life-threatening condition. While COVID-19 is a multi-system viral illness, the primary pathophysiological threat to both the mother and the feto-placental unit is maternal hypoxemia. An oxygen saturation of 88% on room air indicates severe impairment in gas exchange and constitutes a critical hypoxic state. This directly compromises oxygen delivery to vital maternal organs and, crucially, reduces placental perfusion and oxygen transfer to the fetus. The provided evidence underscores that SARS-CoV-2 infection during pregnancy induces significant placental morphological changes, including maternal vascular malperfusion and fibrinoid necrosis, which already place the feto-placental unit under stress [1]. Superimposed maternal hypoxia from respiratory failure exponentially increases the risk of fetal distress, intrauterine growth restriction, or stillbirth. Therefore, correcting this oxygen deficit is the immediate priority to prevent irreversible harm to both patients. The other options represent common, non-life-threatening manifestations of mild to moderate COVID-19. A mild headache and fatigue (Option 1) are constitutional symptoms that, while uncomfortable, do not signal an immediate threat to maternal-fetal oxygenation. Loss of taste and smell (Option 3) is a neurological symptom characteristic of SARS-CoV-2 but is benign in nature and does not require urgent intervention. A low-grade fever of 100.2°F (37.9°C) (Option 4) is a common immune response and, at this level, does not pose an acute danger, though sustained hyperthermia would be a concern. In the hierarchy of nursing priorities, a critically low oxygen saturation indicating respiratory failure always supersedes stable, non-emergent symptoms. References (research sources) - [1]The effects of COVID-19 on placental morphology.Research articleHeeralall C, Ibrahim UH, Lazarus L, Gathiram P, Mackraj I. (2023) · DOI: 10.1016/j.placenta.2023.05.009 ## 임상 시나리오 Clinical Scenario A 30-year-old gravid client at 32 weeks gestation with confirmed COVID-19 presents to the obstetric triage unit. The nurse applies a pulse oximeter and notes an oxygen saturation (SpO2) of 88% on room air. The client is alert but appears tachypneic. Immediate Nursing Actions - Administer supplemental oxygen immediately via a non-rebreather mask at 10-15 L/min to target SpO2 ≥ 95% for pregnant patients. - Position the client in the left lateral tilt or upright position to relieve aortocaval compression and optimize placental perfusion. - Initiate continuous electronic fetal monitoring (EFM) to assess for signs of fetal distress, such as late decelerations or minimal variability. - Notify the obstetric and medical provider or rapid response team of the critical hypoxemia and prepare for possible transfer to a higher level of care. - Obtain arterial blood gas (ABG) analysis to evaluate the degree of hypoxemia and acid-base status. Clinical Rationale Maternal SpO2 below 92% represents a critical threshold in pregnancy. The fetal hemoglobin dissociation curve is shifted to the left, meaning fetal hemoglobin has a higher affinity for oxygen but releases it at lower partial pressures. Maternal hypoxia rapidly depletes fetal oxygen reserves, leading to anaerobic metabolism and acidemia. COVID-19 placental pathology, including maternal vascular malperfusion and fibrinoid necrosis, further reduces the functional surface area for gas exchange. Delaying oxygen therapy risks fetal neurological injury or intrauterine demise. Ongoing Monitoring - Monitor maternal SpO2 continuously and titrate oxygen to maintain levels above 95%. - Assess maternal respiratory rate, depth, and use of accessory muscles every 15 minutes. - Evaluate fetal heart rate tracing for Category II or III patterns indicating worsening fetal status. - Monitor for signs of maternal deterioration, such as altered mental status or hypotension, which may necessitate emergent delivery. ## 핵심 개념 - **Maternal hypoxemia** — A condition in which the mother's blood oxygen level is abnormally low, compromising oxygen delivery to vital organs and the placenta. - **Placental malperfusion** — Reduced blood flow through the placenta, often caused by vascular changes from SARS-CoV-2 infection, impairing nutrient and oxygen transfer to the fetus. - **ABC priority framework** — A triage model that prioritizes Airway, Breathing, and Circulation to identify and manage the most immediately life-threatening conditions first. - **Fibrinoid necrosis** — A pathological change in placental tissue associated with COVID-19, characterized by deposition of fibrin-like material and cell death in the vessel walls. - **Intrauterine growth restriction (IUGR)** — A condition where the fetus does not grow to its expected size, often due to chronic placental insufficiency or maternal hypoxia. ## 같은 주제 문제 - [A 28-year-old pregnant woman at 32 weeks gestation presents to the emergency department wi…](https://mymerci.kr/pages/nclex_q.php?qn_id=542925) - [A 22-year-old pregnant woman at 36 weeks gestation presents to the obstetric unit with con…](https://mymerci.kr/pages/nclex_q.php?qn_id=542926) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._