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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.