Upon entering the room of a client who has had a spontaneous abortion, the nurse observes the client crying. Which response by the nurse would be most appropriate?
I'm sorry you lost your baby.
Why are you crying?
Will a pill help your pain?
A baby still wasn't formed in your womb.
The Correct Answer is A
Choice A Reason: This is the correct answer because it is an empathetic and supportive response that acknowledges the client's loss and grief. This is an empathetic and supportive response that acknowledges the client's loss and grief. The other choices are inappropriate because they are insensitive, dismissive, or inaccurate.
Choice B Reason: This is an inappropriate answer because it implies that the nurse does not understand or care about the client's emotional state. It also suggests that the client has no Reason to cry, which is invalidating and hurtful.
Choice C Reason: This is an inappropriate answer because it focuses on the physical pain rather than the emotional pain of the client. It also implies that the nurse wants to avoid dealing with the client's feelings and just give them a medication to make them stop crying.
Choice D Reason: This is an inappropriate answer because it is inaccurate and misleading. A spontaneous abortion, also known as a miscarriage, occurs when a pregnancy ends before 20 weeks of gestation. At this stage, the baby is already formed and has a heartbeat, organs, and limbs. Saying that a baby still wasn't formed in the womb is false and insensitive to the client's loss.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason: This option is incorrect because it is unrealistic and impractical to eliminate anxiety completely. Anxiety is a normal and natural response to pregnancy and childbirth, and it can have both positive and negative effects on the outcome. Anxiety can motivate women and their partners to seek information and care, but it can also interfere with their ability to relax and cope with pain. Perinatal education can help them manage their anxiety by providing accurate information, reassurance, and coping strategies.
Choice B Reason: This option is incorrect because it implies that the couple has no control over their pregnancy and birth unless they are empowered by perinatal education. While perinatal education can enhance their sense of control and autonomy, it is not the only factor that influences their experience. Pregnancy and birth are complex and dynamic processes that involve many factors beyond their control, such as biological, environmental, social, and cultural factors. Perinatal education can help them adapt to these factors and collaborate with their health care providers.
Choice C Reason: Perinatal education is a process of providing information and support to pregnant women and their partners before, during, and after childbirth. The main goal of perinatal education is to help them prepare for a positive birth experience, which can have lasting benefits for their physical and emotional health, as well as their relationship with their baby. Perinatal education can also help them make informed decisions about their care and preferences, and cope with any challenges or complications that may arise.
Choice D Reason: This option is incorrect because it is too narrow and limited in scope. Providing knowledge and skills that will help them cope with labor is an important aspect of perinatal education, but it is not the primary goal. Labor is only one stage of childbirth, and perinatal education covers a broader range of topics that are relevant for pregnancy, birth, and postpartum. Moreover, coping with labor is not the only outcome that matters for a positive birth experience. Perinatal education can also help them achieve other outcomes, such as satisfaction, empowerment, bonding, and well-being.
Correct Answer is B
Explanation
Choice A Reason: This is incorrect because difficulty in arousing is a sign of magnesium toxicity, which is a serious complication of magnesium sulfate therapy. Magnesium toxicity can cause central nervous system depression, muscle weakness, and cardiac arrest. The nurse should monitor the client's level of consciousness and stop the infusion if the client becomes lethargic or unresponsive.
Choice B Reason: This is correct because deep tendon reflexes 2+ indicate a normal and expected response to magnesium sulfate therapy. Magnesium sulfate is a muscle relaxant that can reduce the risk of seizures in gestational hypertension. The nurse should assess the client's deep tendon reflexes regularly and maintain them at 2+ or slightly diminished.
Choice C Reason: This is incorrect because urinary output of 30 mL per hour is below the normal range of 40 to 80 mL per hour and may indicate renal impairment or dehydration. Magnesium sulfate can cause renal toxicity or fluid retention, which can affect the urinary output. The nurse should monitor the client's urinary output and fluid balance and report any abnormalities to the doctor.
Choice D Reason: This is incorrect because respiratory rate of 10 breaths/minute is below the normal range of 12 to 20 breaths/minute and may indicate respiratory depression. Magnesium sulfate can cause respiratory depression or failure, which can be life-threatening. The nurse should monitor the client's respiratory rate and oxygen saturation and administer oxygen or antidote if needed.
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