A client at 39-weeks gestation presents to labor and delivery with contractions occurring at regular intervals. Her obstetrical history includes a miscarriage at 16-weeks gestation and fetal demise at 31-weeks gestation.
How should the practical nurse (PN) record the client's gravida?
Gravida 4.
Gravida 2.
Gravida 1.
Gravida 3.
The Correct Answer is D
The correct answer is Choice D.
Choice A rationale: This choice incorrectly counts four pregnancies. Scientifically, gravida includes all confirmed pregnancies, but only those that actually occurred. The client has had one miscarriage, one fetal demise, and is currently pregnant—totaling three pregnancies. Counting four would imply an additional pregnancy that did not occur. Overestimating gravida can lead to inaccurate obstetric records and misinterpretation of reproductive history, which may affect clinical decision-making and risk assessment.
Choice B rationale: This choice undercounts the total number of pregnancies by only including two. It likely omits either the miscarriage or the current pregnancy. Scientifically, all pregnancies are counted in gravida, regardless of gestational age or outcome. Miscarriages and fetal demises are included. Underreporting gravida can lead to incomplete obstetric history, which may compromise prenatal care and risk evaluation during labor and delivery.
Choice C rationale: This choice significantly underestimates the gravida by counting only one pregnancy. It may reflect a misunderstanding that only the current or viable pregnancies are included. However, from a clinical standpoint, gravida includes all pregnancies, including those that ended in miscarriage or fetal demise. Accurate gravida documentation is essential for assessing maternal risk factors and planning appropriate obstetric care.
Choice D rationale: This is the correct interpretation. The client has had three pregnancies: one miscarriage at 16 weeks, one fetal demise at 31 weeks, and the current pregnancy at 39 weeks. Scientifically, gravida includes all pregnancies regardless of outcome. This total of three pregnancies makes her gravida 3. Accurate documentation of gravida is crucial for understanding reproductive history and guiding prenatal and intrapartum care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Involution is the process by which the uterus returns to its non-pregnant state, involving uterine contractions that decrease uterine size and minimize blood loss. Problems with involution, such as subinvolution, would typically present with prolonged lochial discharge and a boggy uterus, not primarily severe cramping immediately following breastfeeding.
Choice B rationale
An ileus is a temporary lack of normal muscle contractions in the intestines, leading to a build-up of food material. This condition would manifest as abdominal distension, absent bowel sounds, nausea, and vomiting. While possible post-delivery, it is not directly related to breastfeeding and would not typically cause severe cramping immediately after nursing.
Choice C rationale
A retained placenta refers to fragments of the placenta remaining in the uterus after delivery. This condition typically causes persistent postpartum bleeding, uterine atony, and a risk of infection. While it can cause uterine cramping due to the body's attempts to expel the tissue, the severe cramping immediately after breastfeeding is more directly related to hormonal release.
Choice D rationale
Breastfeeding stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is a hormone that causes uterine contractions, which are essential for uterine involution and preventing postpartum hemorrhage by compressing blood vessels. These contractions, often referred to as "afterpains," are more pronounced during breastfeeding due to the surge in oxytocin.
Correct Answer is D
Explanation
Choice A rationale
While postpartum depression is a serious concern, immediately jumping to a question about suicidal thoughts can be alarming and may shut down communication unless other specific warning signs are present. A more gentle and open-ended approach is generally preferred initially to build rapport and gather information.
Choice B rationale
While it is true that many new mothers experience challenges with bonding, simply stating this without further exploration can minimize the client's feelings and prevent her from elaborating. It does not provide an opportunity for the client to express the depth or specifics of her emotional experience.
Choice C rationale
Focusing on the husband's bonding shifts the attention away from the client's expressed feelings and needs. While partner involvement is important, the immediate priority is to address the client's own emotional state and her perceived lack of bonding with her baby.
Choice D rationale
Encouraging the client to talk about her feelings provides an open-ended opportunity for her to express her concerns, explore the contributing factors, and feel heard. This therapeutic communication technique allows the nurse to gather more specific data and assess for potential postpartum mood disorders or other issues, promoting a client-centered approach.
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