A nurse is planning care for a client who is at 10 weeks of gestation and reports abdominal pain and moderate vaginal bleeding. The tentative diagnosis is inevitable abortion. Which of the following nursing interventions should be included in the plan of care?

Choice A reason: AFI stands for amniotic fluid index, which is a measurement of the amount of amniotic fluid surrounding the fetus. AFI is an indicator of fetal well-being, as it reflects the fetal urine output and the placental function. A normal AFI is between 5 and 25 cm. A low AFI (< 5 cm) can suggest fetal growth restriction, oligohydramnios, or fetal distress. A high AFI (> 25 cm) can suggest fetal anomalies, polyhydramnios, or maternal diabetes.

Choice B reason: Fetal heart rate is an assessment of the fetal cardiac activity, which is usually monitored by a non-stress test (NST). Fetal heart rate is an indicator of fetal well-being, as it reflects the fetal oxygenation and the autonomic nervous system. A normal fetal heart rate is between 110 and 160 beats per minute, with moderate variability and accelerations. A non-reactive fetal heart rate (< 2 accelerations in 20 minutes) can suggest fetal hypoxia, acidosis, or distress.

Choice C reason: Fetal movement is an assessment of the fetal gross body movements, which are usually counted by the mother or observed by ultrasound. Fetal movement is an indicator of fetal well-being, as it reflects the fetal activity and the central nervous system. A normal fetal movement is at least 3 movements in 30 minutes. A decreased fetal movement (< 3 movements in 2 hours) can suggest fetal sleep, sedation, or distress.

Choice D reason: Fetal tone is an assessment of the fetal muscle tone, which is usually observed by ultrasound. Fetal tone is an indicator of fetal well-being, as it reflects the fetal maturity and the neuromuscular system. A normal fetal tone is at least 1 episode of fetal flexion or extension in 30 minutes. An abnormal fetal tone (absent or hypotonic) can suggest fetal immaturity, anomalies, or distress.

Choice E reason: Placental grade is not an assessment that is included in the fetal biophysical profile (BPP), as it is not a direct measure of fetal well-being, but rather a classification of the placental maturity and calcification. Placental grade is usually evaluated by ultrasound, and it ranges from 0 to 3, with higher grades indicating more calcification and aging. Placental grade can affect the placental function and the fetal growth, but it is not a reliable or consistent indicator of fetal distress.

Choice A reason: Reinforcing postpartum and newborn care discharge teaching is not a priority action by the nurse, as it is not directly related to the client's emotional state or safety. Reinforcing postpartum and newborn care discharge teaching is an important intervention that can help the client to manage her physical recovery and her infant's needs, but it is not sufficient to address the client's symptoms of postpartum depression, which is a mood disorder that can affect the client's mental health and well-being.

Choice B reason: Asking the client if she has considered harming her newborn is a priority action by the nurse, as it is essential to assess the client's risk of infanticide, which is the intentional killing of an infant by the mother. Asking the client if she has considered harming her newborn is a sensitive and difficult question, but it is necessary to ensure the safety of the infant and the mother, and to provide appropriate interventions and referrals. The nurse should ask the question in a nonjudgmental and supportive manner, and validate the client's feelings and concerns.

Choice C reason: Assisting the family to identify prior use of positive coping skills in family crises is not a priority action by the nurse, as it is not directly related to the client's emotional state or safety. Assisting the family to identify prior use of positive coping skills in family crises is a helpful intervention that can enhance the client's resilience and self-efficacy, but it is not sufficient to address the client's symptoms of postpartum depression, which is a mood disorder that can affect the client's mental health and well-being.

Choice D reason: Anticipating a prescription by the provider for an antidepressant is not a priority action by the nurse, as it is not directly related to the client's emotional state or safety. Anticipating a prescription by the provider for an antidepressant is a possible intervention that can improve the client's mood and functioning, but it is not the only or the first option to address the client's symptoms of postpartum depression, which is a mood disorder that can affect the client's mental health and well-being. The nurse should collaborate with the provider and the client to determine the best treatment plan, which may include psychotherapy, social support, or alternative therapies.