A nurse in an ambulatory surgery center is providing discharge teaching to a client who had a dilation and curettage (D&C) following a spontaneous miscarriage.
Which of the following should be included in the teaching?
Vaginal intercourse can be resumed after 2 weeks.
Increased intake of zinc-rich foods is recommended.
Aspirin may be taken for cramps.
Products of conception will be present in vaginal bleeding.
The Correct Answer is A
Choice A rationale
Following a dilation and curettage (D&C) for a spontaneous miscarriage, the uterus needs time to heal. Resuming vaginal intercourse after approximately 2 weeks allows for some initial healing of the uterine lining and helps reduce the risk of infection. Healthcare providers typically advise waiting until bleeding has significantly decreased and discomfort has subsided.
Choice B rationale
While adequate nutrition is important for overall recovery after a miscarriage, there is no specific recommendation to increase the intake of zinc-rich foods in particular. A balanced diet supporting tissue repair is generally advised.
Choice C rationale
Aspirin is a salicylate and has antiplatelet properties. It is generally not recommended for managing cramps after a D&C due to the increased risk of bleeding. Acetaminophen or ibuprofen are typically preferred for pain relief.
Choice D rationale
Following a D&C for a spontaneous miscarriage, the products of conception have been removed from the uterus. While some vaginal bleeding is expected as the uterus heals, it should not contain identifiable fetal or placental tissue. Persistent passage of such tissue could indicate an incomplete evacuation or other complications requiring medical attention. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
Explanation
Upon reviewing the client’s medical record, the nurse determines that the client is at risk for developing choriocarcinoma and thyrotoxicosis.
Rationale for correct answers
Choriocarcinoma is a malignant form of gestational trophoblastic disease (GTD) that arises from a molar pregnancy, as evidenced by grape-like vesicles seen on ultrasound and excessively elevated beta-hCG (normal in pregnancy: up to 100,000 mIU/mL by late first trimester). This condition can lead to metastases if not diagnosed and treated promptly.
Thyrotoxicosis occurs due to excess beta-hCG, which stimulates thyroid hormone production. This is supported by the slightly elevated free T4 levels, a common feature of molar pregnancy-related hyperthyroidism.
Rationale for incorrect Response 1 options
- Preterm labor: The client is at 20 weeks with no contractions noted, and cervical changes are not reported.
- Placenta previa: Characterized by painless bright red bleeding later in pregnancy; this client has dark brown discharge consistent with molar pregnancy.
- Cardiac arrhythmia: No evidence of electrolyte abnormalities or arrhythmogenic conditions such as hyperkalemia.
Rationale for incorrect Response 2 options
- Preeclampsia: Normal blood pressure (≥140/90 mm Hg would be concerning); no proteinuria.
- Urinary tract infection: No leukocytes, nitrites, or dysuria reported.
- Hypoglycemia: Normal serum glucose levels; vomiting history does not indicate hypoglycemia.
Correct Answer is D
Explanation
Choice A rationale
Misoprostol is a prostaglandin analog that stimulates uterine contractions. It is contraindicated in clients with placenta previa due to the risk of severe hemorrhage from placental separation if contractions are induced.
Choice B rationale
Active genital herpes is a contraindication for vaginal delivery and therefore also a contraindication for induction of labor with Misoprostol, as it could potentially lead to vertical transmission of the herpes simplex virus to the newborn during passage through the birth canal.
Choice C rationale
A previous uterine incision due to multiple myomectomy can be a contraindication for labor induction with Misoprostol, depending on the type and location of the incisions. The increased risk of uterine rupture with strong contractions stimulated by Misoprostol is a significant concern in such cases.
Choice D rationale
Gestational hypertension, in the absence of other contraindications, can be an indication for induction of labor if the benefits of delivering the baby outweigh the risks of continuing the pregnancy. Misoprostol can be used cautiously in this situation to ripen the cervix and induce labor.
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