A 12-week pregnant client presents for a routine checkup. She reports no vaginal bleeding or cramping, but her last fetal heartbeat detected on ultrasound is absent. The cervix is closed, and the client feels no fetal movement. Which type of miscarriage does the nurse suspect?

Threatened miscarriage

Incomplete miscarriage

Missed miscarriage

Inevitable miscarriage

Answer and Explanation

The Correct Answer is C

A. A threatened miscarriage is characterized by vaginal bleeding, mild cramping, and a closed cervix, but the fetus is still viable with a detectable heartbeat. In this case, the fetal heartbeat is absent, making a threatened miscarriage unlikely.

B. An incomplete miscarriage occurs when some products of conception have been expelled while others remain in the uterus. It is usually accompanied by heavy bleeding, cramping, and an open cervix. This client has a closed cervix and no bleeding, ruling out an incomplete miscarriage.

C. A missed miscarriage occurs when the fetus has died in utero but has not been expelled. The client may have no symptoms—no bleeding or cramping—and the cervix remains closed. Ultrasound confirms the absence of fetal cardiac activity, which matches this presentation. Missed miscarriages often require medical or surgical management to prevent complications such as infection or coagulopathy.

D. An inevitable miscarriage is indicated by vaginal bleeding, cramping, and cervical dilation, suggesting that miscarriage is in progress and cannot be prevented. Since this client has a closed cervix and no active bleeding, an inevitable miscarriage is unlikely.

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Correct Answer is D

Explanation

A. Differentiation refers to the progression from simple, global behaviors to more complex, specific skills, such as grasping with fingers instead of the whole hand. While differentiation occurs during development, the sequence described focuses on head-to-toe progression, not skill refinement.

B. Proximodistal development describes growth and skill acquisition from the center of the body outward (e.g., control of the trunk before the hands and fingers). The sequence in this example emphasizes head and upper body control first, not central-to-peripheral development.

C. Individual differences refer to the variations in the timing and rate at which children reach developmental milestones. While relevant, this principle does not explain the specific head-to-toe progression demonstrated.

D. Cephalocaudal development refers to growth and motor control that progresses from head to tail (top to bottom). The infant first gains control of the head and neck, then the upper body, and later the lower body and sitting posture. This head-to-toe pattern of motor development is exemplified by lifting the head, rolling over, and sitting with support.

A. grunting B. increased appetite C. inspiratory stridor D. retractions E. nasal flaring

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

Explanation

A. Grunting is an expiratory sound produced when a newborn partially closes the glottis during exhalation. This helps maintain positive airway pressure, keeps alveoli open, and improves oxygenation. Persistent grunting indicates the newborn is working hard to breathe and is a classic early sign of respiratory distress.

B. Increased appetite is not a symptom of respiratory distress. In fact, newborns experiencing distress often have difficulty feeding or show poor coordination of sucking and swallowing because breathing requires increased effort. Feeding difficulties, rather than increased appetite, may accompany respiratory compromise.

C. Stridor is a high-pitched sound heard during inspiration, typically caused by upper airway obstruction. It may result from conditions such as laryngomalacia, vocal cord paralysis, or airway edema. Stridor is a red flag for respiratory compromise and requires prompt assessment and monitoring.

D. Retractions occur when a newborn uses accessory muscles to breathe, pulling the skin inward around the sternum, ribs, or clavicles. This indicates increased work of breathing and reduced lung compliance. Retractions are a reliable physical sign of significant respiratory distress.

E. Nasal flaring occurs when the nostrils widen during inspiration to increase airflow. It is one of the earliest visible signs of respiratory distress and signals that the newborn is compensating for hypoxia or increased airway resistance.

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A 12-week pregnant client presents for a routine checkup. She reports no vaginal bleeding or cramping, but her last fetal heartbeat detected on ultrasound is absent. The cervix is closed, and the client feels no fetal movement. Which type of miscarriage does the nurse suspect?

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A 6-month-old infant is able to lift the head while lying on the stomach, then roll over, and eventually sit with support. This sequence BEST demonstrates which principle of growth and development?

Correct Answer is D

Explanation

The nurse is assessing a newborn who is 12 hours old. Which symptoms would indicate the newborn is experiencing respiratory distress?(Select all that apply)

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

Explanation

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A 12-week pregnant client presents for a routine checkup. She reports no vaginal bleeding or cramping, but her last fetal heartbeat detected on ultrasound is absent. The cervix is closed, and the client feels no fetal movement. Which type of miscarriage does the nurse suspect?