A nurse is assisting with the admission of a client who is at 10 weeks of gestation and reports abdominal pain and moderate vaginal bleeding.

Incomplete abortion is the initial diagnosis.

Which of the following actions should the nurse contribute to the client’s plan of care?

Choice A:

Fetal heart tone location: In a frank breech presentation, the fetal buttocks are positioned downward and the legs are extended straight up toward the head, placing the fetal heart closer to the mother's upper abdomen. This results in fetal heart tones being heard above the umbilicus at midline.

Gestation period: At 9 weeks of gestation, the fetus is still small and has ample room to move within the uterus, making breech presentations more common. However, it's important to note that the ideal position for childbirth is cephalic, with the head down.

Other presentations:

Cephalic presentations typically have fetal heart tones below the umbilicus.

Transverse presentations usually have fetal heart tones laterally, off to one side of the abdomen.

Posterior presentations, while still head down, can have fetal heart tones that are difficult to locate or muffled due to the position of the fetal back against the mother's spine.

Choice B:

Fetal position: In a transverse presentation, the fetus is positioned horizontally across the uterus, with the head and buttocks on either side. This typically results in fetal heart tones being heard laterally, rather than above the umbilicus at midline.

Choice C:

Fetal position: In a cephalic presentation, the fetus is head down, with the buttocks near the fundus of the uterus. This usually results in fetal heart tones being heard below the umbilicus, rather than above it.

Choice D:

Fetal position: In a posterior presentation, the fetus is head down, but facing the mother's back. While this can sometimes make fetal heart tones difficult to locate, they are typically still heard below the umbilicus, rather than above it.

Choice A rationale:

Maternal smoking is a major risk factor for low birth weight. Studies have consistently shown that infants born to mothers who smoke during pregnancy are more likely to be born prematurely and have a lower birth weight compared to infants born to non-smoking mothers.

Nicotine, a primary component in cigarettes, is a vasoconstrictor that reduces blood flow to the placenta. This decreased blood flow can deprive the developing fetus of oxygen and essential nutrients, leading to impaired growth and development.

Carbon monoxide, another harmful substance in cigarette smoke, binds to hemoglobin in the blood, reducing its ability to carry oxygen. This can also contribute to fetal hypoxia and growth restriction.

Smoking can also interfere with placental function, further compromising the delivery of nutrients and oxygen to the fetus.

Choice B rationale:

While some studies have suggested a possible link between maternal smoking and hyperactivity in children, the evidence is not conclusive. Further research is needed to establish a definitive association.

Choice C rationale:

There is no clear evidence to suggest that maternal smoking directly causes hypersensitivity to noise in newborns.

Choice D rationale:

Craniofacial abnormalities are not typically associated with maternal smoking. They are more commonly caused by genetic factors or exposure to certain medications or substances during pregnancy.