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?

The GTPAL system is a way of describing a woman's obstetric history using five digits: G (gravida), T (term births), P (preterm births), A (abortions), and L (living children). The client's present parity can be calculated as follows:


G: The client is gravida 4, as she has been pregnant four times, including the current one.
T: The client has had one term birth, as she delivered twins at 36 weeks, which is considered term for a multiple gestation.
P: The client has had no preterm births, as she has not delivered any babies before 37 weeks of gestation. A: The client has had two abortions, one elective and one spontaneous, both before 20 weeks of gestation. L: The client has two living children, the twins she delivered at term.

Therefore, the client's present parity is 2-0-1-2-2.


The other options are incorrect and do not reflect the client's obstetric history.

c. "This is expected because of the way iron is broken down during digestion."

The client's stools are black because of the iron supplements, which can cause a harmless change in the color and consistency of the stools. This is due to the oxidation of iron in the gastrointestinal tract, which produces a black pigment called ferrous sulfide. This is not a sign of bleeding or infection and does not require further evaluation or treatment. The nurse should reassure the client that this is a normal side effect of iron supplements and advise her to continue taking them as prescribed.

The other responses are not appropriate and may cause unnecessary anxiety or inconvenience for the client.

The nurse should not ask the client what else she has been eating, as this implies that her diet may be causing her stools to be black. This may confuse or offend the client, who may think that the nurse is questioning her nutritional choices or blaming her for her condition.

The nurse should not tell the client to go to the emergency room, as this suggests that her stools are black because of a serious problem that needs immediate atention. This may frighten or alarm the client, who may think that she or her baby are in danger.

d. The nurse should not tell the client to come to the office, as this indicates that her stools are black because of an abnormal finding that needs further investigation. This may worry or inconvenience the client, who may think that she has a complication or infection that requires testing or treatment.