A 19-year-old client comes to the clinic seeking information about the use of the morning-after pill (levonorgestrel) for emergency contraception.
Which of the following statements made by the client indicates a need for further teaching?

Choice A rationale

The fetal heart indeed pumps blood to both the placenta, where oxygen and nutrients are obtained, and to the developing organs, which require these substances for growth and function. This dual circulation is essential for fetal development. The normal circulatory pattern ensures that oxygenated blood returns from the placenta to nourish the fetal tissues, while deoxygenated blood is transported back to the placenta for gas exchange.

Choice B rationale

Maternal and fetal blood do not mix under normal physiological conditions. The exchange of gases, nutrients, and waste products occurs across the placental barrier, which consists of fetal and maternal tissues but keeps their bloodstreams separate. This separation prevents potential immune reactions and maintains distinct circulatory systems for the mother and the fetus.

Choice C rationale

The placenta serves as the vital site for gas exchange in the fetus. Oxygen and carbon dioxide are exchanged between the maternal and fetal blood across the placental membranes via diffusion. Oxygen-rich blood from the mother is delivered to the fetus, while carbon dioxide, a waste product of fetal metabolism, moves from the fetus to the mother for elimination.

Choice D rationale

The umbilical arteries are responsible for carrying deoxygenated blood and waste products from the fetus to the placenta. This deoxygenated blood is then oxygenated and cleared of waste at the placenta before returning to the fetus via the umbilical vein. This flow pattern is crucial for maintaining the fetal environment and supporting its development.

1. Blood pressure (Worsening):

   • Elevated or worsening blood pressure can indicate the progression of hypertension or a related condition, such as preeclampsia. It’s a serious sign that needs immediate attention.

2. Deep tendon reflexes (DTR) (Worsening):

   • Increased or hyperactive deep tendon reflexes often indicate an abnormal neurological or medical condition, such as preeclampsia or nervous system distress. This worsening could signal a more severe condition, needing further evaluation.

3. Vaginal exam (client denies pain) (Unrelated):

   • The absence of pain during a vaginal exam may not be directly related to the client’s overall worsening or improving condition. It’s neutral in terms of contributing to any significant changes in the client’s condition.

4. Decreased sensation in legs (Worsening):

   • A worsening loss of sensation in the legs can suggest a neurological issue, such as nerve compression or even complications from a vascular condition. This condition is concerning, as it indicates progression and requires immediate investigation.

5. Creatinine (Worsening):

   • Elevated creatinine levels are a marker of kidney dysfunction or damage. If creatinine levels are worsening, it indicates a decline in kidney function, which could be a sign of renal failure or preeclampsia and needs urgent attention.