A nurse in a prenatal clinic is reviewing the medical record of a client who is at 28 weeks of gestation. The client's history reveals one pregnancy terminated by elective abortion at 9 weeks; the birth of twins at 36 weeks; and a spontaneous abortion at 15 weeks of gestation. According to the GTPAL system, which of the following describes her present parity?
4-0-0-2-2
4-2-0-2-2
4-0-2-2-2
4-0-1-2-2
The Correct Answer is D
G (Gravida) — Total number of pregnancies, including the current one.
Elective abortion at 9 weeks
Birth of twins at 36 weeks
Spontaneous abortion at 15 weeks
Current pregnancy at 28 weeks So, G = 4.
T (Term births) — Number of pregnancies carried to 37 weeks or beyond.
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- She hasn't had any pregnancies reach full term. So, T = 0.
P (Preterm births) — Number of pregnancies delivered between 20 and 36 weeks.
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- Twins born at 36 weeks. So, P = 1.
A (Abortions) — Number of pregnancies ending before 20 weeks (spontaneous or elective).
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- Elective abortion at 9 weeks
- Spontaneous abortion at 15 weeks So, A = 2.
L (Living children) — Number of living children.
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- The twins are living children. So, L = 2.
Putting it all together, her GTPAL notation is G4 T0 P1 A2 L2.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The nurse should check the client's fundus first, as this is the most likely source of bleeding and clots in the postpartum period. The fundus is the upper part of the uterus that contracts and involutes after delivery to prevent hemorrhage. The nurse should palpate the fundus for firmness, height, and position, and massage it gently if it is boggy or displaced. A soft, high, or deviated fundus may indicate uterine atony or retained placental fragments, which can cause excessive bleeding and clots.
Correct Answer is C
Explanation
Choice A reason: Maternal battering or abdominal trauma is a significant cause of placental abruption, but it is not the most frequent. Trauma accounts for a smaller percentage of cases compared to chronic vascular conditions. While it requires immediate screening, it is categorized as an acute mechanical trigger rather than the primary underlying systemic risk factor.
Choice B reason: Cigarette smoking increases the risk of placental abruption due to vasoconstriction and placental hypoperfusion. While smoking is a modifiable risk factor associated with various adverse pregnancy outcomes, research cited by the NIH indicates it is less prevalent as a primary cause compared to the high incidence of hypertensive disorders in pregnancy.
Choice C reason: Maternal hypertension, whether chronic or pregnancy-induced (preeclampsia), is the most common risk factor for placental abruption. High blood pressure causes vascular changes and vasospasms that lead to reduced blood flow and potential separation of the placenta from the uterine wall. This is a leading cause in clinical textbooks.
Choice D reason: Maternal cocaine use is a known risk factor because it causes sudden, severe vasoconstriction and sharp increases in blood pressure. Although this can lead to catastrophic placental separation, the overall frequency of cocaine-induced abruption in the general population is lower than that caused by the widespread prevalence of hypertensive disorders.
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