A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding.
A threatened abortion is suspected, and the nurse instructs the client regarding management of care.
Which statement, if made by the client, indicates a need for further education?

Choice A rationale

Following a dilation and curettage (D&C) for a spontaneous miscarriage, the uterus needs time to heal. Resuming vaginal intercourse after approximately 2 weeks allows for some initial healing of the uterine lining and helps reduce the risk of infection. Healthcare providers typically advise waiting until bleeding has significantly decreased and discomfort has subsided.

Choice B rationale

While adequate nutrition is important for overall recovery after a miscarriage, there is no specific recommendation to increase the intake of zinc-rich foods in particular. A balanced diet supporting tissue repair is generally advised.

Choice C rationale

Aspirin is a salicylate and has antiplatelet properties. It is generally not recommended for managing cramps after a D&C due to the increased risk of bleeding. Acetaminophen or ibuprofen are typically preferred for pain relief.

Choice D rationale

Following a D&C for a spontaneous miscarriage, the products of conception have been removed from the uterus. While some vaginal bleeding is expected as the uterus heals, it should not contain identifiable fetal or placental tissue. Persistent passage of such tissue could indicate an incomplete evacuation or other complications requiring medical attention. .

Choice A rationale

Encouraging a hands-and-knees position may help rotate a malpositioned fetus or relieve back pain, but it does not directly address hypotonic uterine dysfunction, which is characterized by weak, ineffective contractions. While it can improve maternal comfort and potentially aid in fetal descent if malpositioning is a contributing factor to slow labor progress, it will not augment the strength or frequency of contractions necessary for cervical dilation.

Choice B rationale

Providing a comfortable environment with dim lighting can promote relaxation and potentially enhance the progress of labor in cases of hypertonic uterine dysfunction (uncoordinated, painful contractions). However, in hypotonic dysfunction, the issue is a lack of adequate uterine muscle activity. While comfort measures are always important, they do not directly stimulate stronger contractions.

Choice C rationale

Administering oxytocin is the primary medical intervention for hypotonic uterine dysfunction. Oxytocin is a synthetic hormone that stimulates uterine smooth muscle to contract more frequently and with greater intensity. This augmentation of uterine activity aims to establish an effective labor pattern, leading to cervical dilation and fetal descent when fetopelvic disproportion has been ruled out.

Choice D rationale

Preparing for an amniotomy (artificial rupture of membranes) might be considered to augment labor if the membranes are intact. However, the question states the membranes have already ruptured. Amniotomy can sometimes stimulate contractions by releasing prostaglandins, but it is not the first-line intervention for established hypotonic dysfunction after membrane rupture, and oxytocin is generally more effective in this situation.