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. .
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Correct Answer is B
Explanation
Choice A rationale
Avoiding sexual intercourse is recommended in the presence of threatened abortion to prevent further uterine irritation and potential disruption of the pregnancy. Pelvic rest helps to minimize the risk of increased bleeding or complications.
Choice B rationale
Continuing with normal life after discharge is an inappropriate statement. With a threatened abortion, the client needs to understand the importance of rest and avoiding strenuous activities that could potentially exacerbate bleeding or lead to further complications. Activities that increase intra-abdominal pressure or cause physical strain should be limited.
Choice C rationale
Counting perineal pads and noting the amount and color of blood is an important instruction for monitoring the extent of bleeding. This information helps the healthcare provider assess the progression or resolution of the threatened abortion and identify any signs of increased bleeding or passage of tissue.
Choice D rationale
Watching for the evidence of the passage of tissue is crucial as it could indicate a progressing miscarriage. The client should be instructed on how to collect any passed tissue for examination by the healthcare provider to confirm the outcome of the pregnancy. .
Correct Answer is ["A","B","C"]
Explanation
Choice A rationale: Primigravida
Primigravida (first-time pregnancy) is a known risk factor for preeclampsia. Studies show that nulliparous individuals (those who have never given birth before) have a higher likelihood of developing preeclampsia compared to multiparous individuals. The exact reason is not fully understood, but it is thought that immunological adaptation plays a role.
Choice B rationale: Age
Advanced maternal age (≥35 years) is a recognized risk factor for preeclampsia. This client is 36 years old, which places her in the higher-risk category. Older maternal age is associated with increased vascular dysfunction and underlying chronic conditions that predispose individuals to preeclampsia.
Choice C rationale: Type 1 diabetes mellitus
Type 1 diabetes mellitus significantly increases the risk of preeclampsia due to its impact on vascular health. Diabetes affects endothelial function and can cause chronic inflammation, both of which contribute to hypertension and proteinuria, hallmark symptoms of preeclampsia. Additionally, diabetes increases the risk of abnormal placentation, further raising the chances of hypertensive disorders in pregnancy.
Choice D rationale: Hemoglobin level
A hemoglobin level of 12.5 g/dL is within the normal range and does not contribute to an increased risk for preeclampsia. While anemia is sometimes associated with preeclampsia, a normal hemoglobin level does not raise concern in this case. Therefore, hemoglobin is not a risk factor for preeclampsia in this patient.
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