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Increase intake of iron. Iron is a mineral that is important for the production of red blood cells and the prevention of anemia in pregnant women. However, iron deficiency does not cause neural tube defects. Iron supplements may be recommended for pregnant women who have low iron levels, but they do not affect the risk of neural tube defects².

Avoid the use of aspirin. Aspirin is a type of nonsteroidal anti-inflammatory drug (NSAID) that can have harmful effects on the fetus if taken during pregnancy, especially in the second and third trimesters. Aspirin can cause kidney problems, bleeding problems, premature closure of a blood vessel in the fetal heart, and increased risk of pregnancy loss¹. However, aspirin does not cause neural tube defects. Low-dose aspirin may be prescribed for some pregnant women who have certain medical conditions that increase the risk of preeclampsia or blood clots, but only under the guidance of a health care provider¹.

Limit consumption of alcohol. Alcohol is a known teratogen that can cause a range of physical, mental, and behavioral problems in the fetus, collectively known as fetal alcohol spectrum disorders (FASD). Alcohol can interfere with the development of the brain and other organs, and cause facial abnormalities, growth problems, learning difficulties, and behavioral issues³. However, alcohol does not cause neural tube defects. There is no safe amount or type of alcohol to drink during pregnancy, and abstaining from alcohol is the best way to prevent FASD³.

Maternal cigarete smoking can cause vasoconstriction and reduced blood flow to the placenta, as well as increase the risk of thrombosis and inflammation in the placental vessels.

Hypertension is the most common risk factor for placental abruption, which occurs when the placenta separates from the uterine wall before delivery. Hypertension can cause damage to the blood vessels that supply the placenta, leading to reduced blood flow and increased pressure in the intervillous space. This can cause hemorrhage and detachment of the placenta.


The other options are not as common as hypertension, but they can also increase the risk of placental abruption by causing trauma, vasoconstriction, or inflammation in the placenta or uterus.

Maternal cocaine use can cause severe vasoconstriction and hypertension, which can impair placental perfusion and cause placental abruption.

Fetal lung maturity is not a concern for a client who is at 38 weeks of gestation, as most fetuses have developed sufficient surfactant production by this time. Fetal lung maturity can be assessed by amniocentesis or by measuring the lecithin/sphingomyelin ratio in the amniotic fluid.

Frequency and duration of contractions are not present in the client's case, as she has no signs of labor. Contractions can be monitored by external or internal tocodynamometry or by palpation.

Rh incompatibility is a condition where the mother's blood type is Rh-negative and the fetus's blood type is Rh- positive, which can cause hemolytic disease of the newborn. Rh incompatibility can be detected by blood tests and prevented by administering Rh immunoglobulin to the mother during pregnancy and after delivery.

The client should limit her carbohydrates to 50% of her daily caloric intake, as carbohydrates have the most impact on blood glucose levels. The client should also choose complex carbohydrates that are high in fiber and low in glycemic index, such as whole grains, fruits, and vegetables.

The client should know that she is at increased risk to develop type 2 diabetes, as gestational diabetes is a risk factor for future diabetes mellitus. The client should undergo screening for diabetes 6 to 12 weeks after delivery and every 1 to 3 years thereafter. The client should also adopt lifestyle modifications such as healthy diet, regular exercise, and weight management to prevent or delay the onset of type 2 diabetes.

The client should take her glyburide daily with breakfast, as glyburide is an oral antidiabetic agent that can be used to treat gestational diabetes when diet and exercise are not enough to control blood glucose levels. Glyburide stimulates the pancreas to produce more insulin and lowers blood glucose levels. Glyburide should be taken with the first meal of the day to avoid hypoglycemia.

The nurse should not ask the client what else she has been eating, as this implies that her diet may be causing her stools to be black. This may confuse or offend the client, who may think that the nurse is questioning her nutritional choices or blaming her for her condition.

The nurse should not tell the client to go to the emergency room, as this suggests that her stools are black because of a serious problem that needs immediate atention. This may frighten or alarm the client, who may think that she or her baby are in danger.

The nurse should not tell the client to come to the office, as this indicates that her stools are black because of an abnormal finding that needs further investigation. This may worry or inconvenience the client, who may think that she has a complication or infection that requires testing or treatment.

Whitish vaginal discharge is not a sign of a hydatidiform mole, but it may be normal in pregnancy due to increased cervical mucus production. However, if the discharge is foul-smelling, yellow, green, or bloody, it may indicate an infection or a complication such as preterm labor or placental abruption.

Fetal heart rate irregularities are not a sign of a hydatidiform mole, but they may indicate fetal distress or congenital anomalies. A hydatidiform mole usually does not have a viable fetus, and fetal heart tones are absent or very faint. The nurse should use a Doppler device or a fetal monitor to assess the fetal heart rate and rhythm.

Rapidly dropping human chorionic gonadotropin (hCG) levels are not a sign of a hydatidiform mole, but they may indicate a spontaneous abortion or an ectopic pregnancy. A hydatidiform mole usually causes very high hCG levels, as the abnormal placental tissue secretes large amounts of this hormone. The nurse should perform a urine or blood test to measure the hCG levels and monitor them for chan

The nurse should measure the client's vital signs, as they can indicate the severity of blood loss and the presence of shock. However, vital signs may not change significantly until a large amount of blood is lost, and they are not specific to the cause of bleeding. Therefore, vital signs are not the first action to take.

The nurse should feel for a full bladder, as it can interfere with uterine contraction and cause bleeding and clots. However, a full bladder is not the most common cause of postpartum hemorrhage, and it can be easily detected by inspecting or percussing the lower abdomen. Therefore, feeling for a full bladder is not the first action to take.

The nurse should request the provider perform a vaginal examination, as it can identify any lacerations or hematomas that may cause bleeding and clots. However, vaginal trauma is not as frequent or as serious as uterine causes of postpartum hemorrhage, and it requires a sterile procedure that may take time to prepare. Therefore, requesting a vaginal examination is not the first action to take.

This option implies that the client has had two term births, no preterm births, no abortions, and two living children, which is not true.

This option implies that the client has never been pregnant, which is not true.

This option implies that the client has had one term birth, no preterm births, two abortions, and two living children, which is not true.

Increased abdominal muscle tone is not an expected change during pregnancy, as the abdominal muscles stretch and weaken to accommodate the growing uterus. Increased abdominal muscle tone may interfere with fetal growth and movement, and may cause diastasis recti, which is the separation of the rectus abdominis muscles along the midline.

Decreased mobility of pelvic joints is not an expected change during pregnancy, as the pelvic joints relax and widen to prepare for delivery. Decreased mobility of pelvic joints may impair fetal descent and rotation, and may cause pelvic pain and dysfunction.

Posterior neck flexion is not an expected change during pregnancy, as the neck should remain in a neutral position to align with the spine. Posterior neck flexion may indicate cervical spine injury or muscle spasm, and may cause neck pain and headaches.

The nurse should not perform a rectal exam, as this can cause trauma or infection to the rectum or the placenta, and increase the risk of bleeding or rupture.

The nurse should not complete a vaginal exam, as this can dislodge or damage the placenta, and cause severe
hemorrhage or shock.

The nurse should not apply ice to the perineal area, as this can cause vasoconstriction and reduce blood flow to the placenta and the fetus, and worsen their condition.

The nurse should not tell the client that a gain of about 25 to 35 pounds is best for her and for her baby, as this is the range of weight gain that is recommended for a pregnant woman who has a normal BMI (18.5 to 24.9). Gaining more weight than necessary can increase the risk of gestational diabetes, hypertension, preeclampsia, cesarean delivery, and postpartum weight retention.

The nurse should tell the client that the recommendation for her is about 15 to 25 pounds, as this is the range of weight gain that is considered healthy and appropriate for a pregnant woman who has a BMI of 26.5, which falls in the overweight category (BMI of 25 to 29.9). The weight gain should be gradual and consistent, with an average of
0.6 pounds per week in the second and third trimesters.

The nurse should not tell the client that she should gain 11 to 20 pounds, as this is the range of weight gain that is advised for a pregnant woman who has a BMI of 30 or higher, which falls in the obese category. Gaining less weight than needed can compromise fetal growth and development, and increase the risk of preterm birth, low birth weight, and intrauterine growth restriction.

Severe nausea and vomiting are not common signs of an ectopic pregnancy, but they may occur in any pregnancy due to hormonal changes or other factors. Severe nausea and vomiting may also indicate hyperemesis gravidarum, which is a condition where nausea and vomiting are so severe that they cause dehydration, electrolyte imbalance, and weight loss.

Copious vaginal bleeding is not a usual sign of an ectopic pregnancy, but it may occur if the ectopic pregnancy ruptures and causes hemorrhage. However, copious vaginal bleeding may also indicate other complications such as placenta previa, placental abruption, or spontaneous abortion.

Uterine enlargement greater than expected for gestational age is not a sign of an ectopic pregnancy, but it may indicate a multiple gestation, hydatidiform mole, polyhydramnios, or a large fetus. An ectopic pregnancy usually causes uterine enlargement less than expected for gestational age, as the uterus does not contain a viable pregnancy.

The nurse should observe for pooling of blood under the butocks, as this can indicate a large amount of blood loss that may not be visible on the perineal pad. However, this is not the first action to take, as it does not address the cause of bleeding or stop it from continuing.

The nurse should assess the client's blood pressure, as this can indicate the severity of blood loss and the presence of shock. However, blood pressure may not change significantly until a large amount of blood is lost, and it is not specific to the cause of bleeding. Therefore, blood pressure is not the first action to take.

The nurse should prepare to administer a prescribed oxytocic preparation, such as oxytocin or methylergonovine, as this can enhance uterine contraction and reduce bleeding. However, this requires a provider's order and may take time to obtain and administer. Therefore, an oxytocic preparation is not the first action to take.

The gender of the fetus can be determined by amniocentesis, as the fetal cells in the amniotic fluid contain chromosomal information that reveals the sex of the fetus. However, this is not a medical indication for amniocentesis, and it can be done by other methods, such as ultrasound or blood test.

The weeks of gestation can be estimated by amniocentesis, as the amount and composition of amniotic fluid change throughout pregnancy. However, this is not a reliable or accurate method of dating pregnancy, and it can be done by other methods, such as last menstrual period, ultrasound, or fundal height measurement.

The anatomic abnormalities of the fetus can be detected by amniocentesis, as the fetal cells in the amniotic fluid can be tested for genetic or chromosomal disorders that may cause structural defects or malformations. However,

This is not a common indication of amniocentesis in preterm labor, and it can be done by other methods, such as ultrasound or blood test.

The nurse should not prepare to administer Rho(D) immune globulin if the record indicates that the client has previously given birth to an Rh-negative infant, as this does not pose a risk of Rh isoimmunization. Rh isoimmunization only occurs when an Rh-negative mother carries an Rh-positive fetus, which can happen if the father is Rh-positive or heterozygous for the Rh antigen.

The nurse should not prepare to administer Rho(D) immune globulin if the record indicates that the client has had significant blood loss during the procedure, as this does not affect the need for Rho(D) immune globulin. Blood loss may require other interventions, such as fluid resuscitation, transfusion, or hemostasis, but it does not change the indication for Rho(D) immune globulin based on the Rh status of the mother and the fetus.

The nurse should not prepare to administer Rho(D) immune globulin if the record indicates that the client has expressed a desire to conceive again, as this does not determine the need for Rho(D) immune globulin. The desire to conceive again may influence the decision to use salpingostomy instead of salpingectomy for ectopic pregnancy, as salpingostomy preserves the fallopian tube and allows for future fertility. However, it does not affect the indication for Rho(D) immune globulin based on the Rh status of the mother and the fetus.

Lightening is the descent of the fetal head into the pelvis, which occurs near the end of pregnancy as the fetus prepares for birth. Lightening may relieve some pressure on the diaphragm and lungs, making breathing easier for the mother, but it may also increase pressure on the bladder and cause more frequent urination. Lightening usually occurs around 36 to 38 weeks of gestation for a primigravida and may occur just before or during labor for a multigravida.

Chloasma is the darkening of the skin on the face, especially around the eyes, nose, and cheeks, which occurs due to increased pigmentation during pregnancy. Chloasma is also known as melasma or the mask of pregnancy, and it may fade after delivery or persist indefinitely. Chloasma is more common in women with darker skin tones or those who are exposed to sunlight.

Ballotement is a technique of palpating the uterus to detect fetal movement, which can be done by a health care provider between 16 and 28 weeks of gestation. Ballotement involves pushing up on the cervix with a finger and feeling a rebound from the floating fetus. Ballotement is not a subjective sensation felt by the mother, but an objective sign observed by the examiner.

"I should limit my carbohydrates to 50% of caloric intake.” This statement is correct, as the client should follow a balanced diet that provides adequate nutrition for herself and her fetus, while controlling blood glucose levels. Carbohydrates are the main source of glucose and should be limited to 50% of caloric intake, distributed evenly throughout the day, and preferably from complex sources such as whole grains, fruits, and vegetables.

"I will take my glyburide daily with breakfast.” This statement is correct, as the client should take her prescribed oral hypoglycemic medication as directed by her provider. Glyburide is a sulfonylurea that stimulates insulin secretion and lowers blood glucose levels. It is usually taken once or twice a day with meals, depending on the dose and blood glucose response.

"I know I am at increased risk to develop type 2 diabetes." This statement is correct, as the client should be aware of the long-term implications of gestational diabetes. Gestational diabetes is a condition where the body becomes resistant to insulin during pregnancy, resulting in high blood glucose levels. It usually resolves after delivery, but it increases the risk of developing type 2 diabetes later in life. The client should monitor her blood glucose levels regularly, maintain a healthy weight, and have screening tests for diabetes every 1 to 3 years.

Decreased energy is a common manifestation during pregnancy, especially in the first and third trimesters, as the body adapts to the increased metabolic and physiologic demands of pregnancy. The client may feel tired, fatigued, or sleepy, and may need more rest and sleep. The client can cope with decreased energy by eating a balanced diet, staying hydrated, exercising moderately, and taking naps when possible.

Mood swings are a common manifestation during pregnancy, as the hormonal and emotional changes of pregnancy affect the mood and mental state of the client. The client may experience fluctuations in mood, such as happiness, sadness, irritability, anxiety, or depression. The client can cope with mood swings by expressing her feelings, seeking support from her partner, family, or friends, practicing relaxation techniques, and seeking professional help if needed.

Urinary frequency is a common manifestation during pregnancy, as the growing uterus puts pressure on the bladder and reduces its capacity. The client may need to urinate more often and in smaller amounts, especially in the first and third trimesters. The client can cope with urinary frequency by drinking plenty of fluids during the day and limiting them at night, emptying the bladder completely when urinating, avoiding caffeine and alcohol, and doing pelvic floor exercises to strengthen the muscles that control urination.

"I should limit my carbohydrates to 50% of caloric intake.” This statement is correct, as the client should follow a balanced diet that provides adequate nutrition for herself and her fetus, while controlling blood glucose levels. Carbohydrates are the main source of glucose and should be limited to 50% of caloric intake, distributed evenly throughout the day, and preferably from complex sources such as whole grains, fruits, and vegetables.

"I will take my glyburide daily with breakfast.” This statement is correct, as the client should take her prescribed oral hypoglycemic medication as directed by her provider. Glyburide is a sulfonylurea that stimulates insulin secretion and lowers blood glucose levels. It is usually taken once or twice a day with meals, depending on the dose and blood glucose response.

"I know I am at increased risk to develop type 2 diabetes." This statement is correct, as the client should be aware of the long-term implications of gestational diabetes. Gestational diabetes is a condition where the body becomes resistant to insulin during pregnancy, resulting in high blood glucose levels. It usually resolves after delivery, but it increases the risk of developing type 2 diabetes later in life. The client should monitor her blood glucose levels regularly, maintain a healthy weight, and have screening tests for diabetes every 1 to 3 years.