A 24-year-old woman arrives at the clinic to confirm her pregnancy.
She has a body mass index (BMI) of 17, admits to occasional cocaine use and alcohol consumption, and has a blood pressure of 108/70 mm Hg. Her family history includes diabetes mellitus and cancer, including a sister who recently gave birth to an infant with a neural tube defect (NTD). Which factors place her in a high-risk category?

Choice A rationale:

Epicanthal folds: These are skin folds that cover the inner corners of the eyes. They are a common characteristic of Trisomy 21, also known as Down syndrome.

Heart murmur: A heart murmur is an abnormal sound heard during a heartbeat. It can be caused by a variety of conditions, including Trisomy 21. Approximately half of babies with Down syndrome have a heart defect.

Low-set ears: This means that the ears are positioned lower on the head than usual. This is another common characteristic of Trisomy 21.

Poor muscle tone: This means that the muscles are weak and floppy. This is also a common characteristic of Trisomy 21.

Choice B rationale:

Cystic fibrosis: This is a genetic disorder that affects the lungs and digestive system. It is not typically associated with the physical features observed in this newborn. Newborns with cystic fibrosis typically present with meconium ileus, failure to thrive, and recurrent respiratory infections.

Choice C rationale:

Tay-Sachs disease: This is a rare genetic disorder that affects the nervous system. It is not typically associated with the physical features observed in this newborn. Infants with Tay-Sachs disease typically appear normal at birth, with symptoms developing around 6 months of age. These symptoms can include developmental delays, muscle weakness, seizures, and blindness.

Choice D rationale:

Marfan syndrome: This is a genetic disorder that affects the connective tissue. It is not typically associated with the physical features observed in this newborn. Individuals with Marfan syndrome typically have tall stature, long limbs, and hypermobile joints. They may also have eye problems, such as lens dislocation, and heart problems, such as aortic aneurysm.

Choice A rationale:

Joining a support group can be beneficial. I can provide some recommendations.

Support groups offer a safe and supportive environment where couples can share their experiences, feelings, and coping strategies with others who understand what they are going through. This can be incredibly helpful in reducing isolation, normalizing their emotions, and promoting a sense of hope. Support groups can also provide valuable information and resources about infertility, treatment options, and coping strategies. Additionally, they can help couples develop a sense of community and belonging, which can be especially important during a challenging time.

I can provide some recommendations for support groups in your area. This demonstrates the nurse's willingness to help the couple find the resources they need and underscores the value of support groups in managing infertility.

Choice B rationale:

Share your situation with friends and family so they can provide support.

While sharing with friends and family can be helpful for some couples, it's important to recognize that not everyone may be able to provide the kind of support that is needed. Some friends and family members may not understand the challenges of infertility or may offer unsolicited advice, which can be hurtful. Additionally, couples may not feel comfortable sharing such personal information with their loved ones. It's important to respect the couple's privacy and preferences in this regard.

Choice C rationale:

Start adoption proceedings immediately as it can be challenging to adopt an infant.

This response is not appropriate as it does not address the couple's immediate concern, which is how to maintain their emotional balance while dealing with infertility. It also assumes that the couple is interested in adoption, which may not be the case. While adoption can be a wonderful option for some families, it's a major decision that requires careful consideration and should not be rushed into.

Choice D rationale:

Speak only with other friends who are dealing with infertility as they can provide the most help.

While connecting with others who are experiencing infertility can be helpful, it's important not to isolate oneself from other sources of support. Friends and family who are not dealing with infertility can still offer valuable support, understanding, and companionship. It's important to have a variety of supportive relationships in one's life.