A nurse is formulating a care plan for a patient who is 10 weeks pregnant and reports abdominal pain and moderate vaginal bleeding.
The preliminary diagnosis is an inevitable abortion.
Which nursing interventions should be included in the care plan?

Maintain the patient on bed rest.

Offer the option to view products of conception.

Administer oxygen via a nasal cannula.

Instruct the patient to increase potassium-rich foods in the diet.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Maintain the patient on bed rest. This is a common nursing intervention for a patient who is experiencing an inevitable abortion. Bed rest can help reduce the risk of further complications, such as heavy bleeding. It can also provide the patient with a chance to rest and recover physically and emotionally.

Choice B rationale

Offer the option to view products of conception. This intervention may not be appropriate for all patients. While some patients may find it helpful to view the products of conception, others may find it distressing. It’s important to discuss this option with the patient and respect her wishes.

Choice C rationale

Administer oxygen via a nasal cannula. This intervention may not be necessary for all patients experiencing an inevitable abortion. While oxygen therapy can be used to treat hypoxia in patients with heavy bleeding, it’s not typically required unless the patient shows signs of hypoxia.

Choice D rationale

Instruct the patient to increase potassium-rich foods in the diet. This intervention is not typically part of the care plan for a patient experiencing an inevitable abortion. While a balanced diet is important for overall health, there’s no specific need to increase potassium-rich foods in the diet in this situation.

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Correct Answer is ["A","B","C","E"]

Explanation

Choice A rationale

Anomalies in fetal chromosomes can be identified through amniocentesis. This test involves the extraction of a small amount of amniotic fluid, which contains fetal tissues. The chromosomes of the fetus can be examined for abnormalities.

Choice B rationale

Cephalopelvic disproportion refers to a condition where the mother’s pelvis is too small to allow the baby to pass through the birth canal. This condition cannot be identified through amniocentesis. Amniocentesis is a diagnostic procedure that examines the amniotic fluid (not the maternal pelvis or the size of the fetus) to detect chromosomal abnormalities and certain genetic disorders.

Choice C rationale

Fetal gender can be determined through amniocentesis. The test can identify the presence of Y chromosomes, which would indicate a male fetus.

Choice D rationale

Rh incompatibility is a condition that occurs when a mother is Rh-negative and the baby is Rh-positive. This condition cannot be identified through amniocentesis. Instead, it is typically identified through blood tests of the mother and father.

Choice E rationale

Neural tube defects, such as spina bifida and anencephaly, can be identified through amniocentesis. The test can detect high levels of alpha-fetoprotein, which is often present when a fetus has a neural tube defect.

A. Very fine hairs, called lanugo, cover your baby’s entire body by week 36 of pregnancy. B. The sex of the baby is determined by week 8 of pregnancy. C. You will first feel your baby move in week 24 of pregnancy. D. The baby’s heartbeat is audible by a Doppler stethoscope at 12 weeks of pregnancy.

Correct Answer is D

Explanation

The correct answer is Choice D

Choice A rationale: Lanugo, very fine hairs, begin to cover the baby's body around week 20, not week 36. These hairs help protect the skin and usually disappear before birth. By week 36, the lanugo has mostly disappeared, and the baby is almost fully developed.

Choice B rationale: The sex of the baby is determined at conception based on the chromosomes carried by the sperm and egg. However, the external genitalia do not become distinguishable until around week 12 of pregnancy, making week 8 too early for sex determination.

Choice C rationale: Most women first feel fetal movements, known as quickening, between weeks 18 and 22, not week 24. This can vary based on individual factors, but week 24 is generally later than the typical range for first fetal movements.

Choice D rationale: The baby's heartbeat can usually be heard using a Doppler stethoscope by around 12 weeks of pregnancy. This marks a significant milestone and reassures expectant parents about their baby's health and development at this early stage

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A nurse is formulating a care plan for a patient who is 10 weeks pregnant and reports abdominal pain and moderate vaginal bleeding.The preliminary diagnosis is an inevitable abortion.Which nursing interventions should be included in the care plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who is at 15 weeks of gestation and is to undergo an amniocentesis.The nurse should explain that the purpose of this test is to identify which of the following conditions?

Correct Answer is ["A","B","C","E"]

Explanation

A nurse is teaching about fetal development to a group of clients in the antenatal clinic. Which of the following statements should the nurse include in the teaching?

Correct Answer is D

Explanation

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A nurse is formulating a care plan for a patient who is 10 weeks pregnant and reports abdominal pain and moderate vaginal bleeding.
The preliminary diagnosis is an inevitable abortion.
Which nursing interventions should be included in the care plan?