A client is admitted with a threatened abortion.
Which assessment findings would the nurse expect? Select all that apply.
Severe cramping and pelvic pain.
Closed cervix upon examination.
Mild to moderate lower abdominal cramping.
Passage of fetal tissue.
Bright red vaginal bleeding.
Answer and explanation
The correct answer is Choice B, Choice C, Choice E.
Choice A rationale
Severe cramping and pelvic pain are more indicative of an inevitable or incomplete abortion, where the pregnancy is no longer viable and the body is actively trying to expel the uterine contents. In a threatened abortion, the symptoms are typically milder.
Choice B rationale
A closed cervix upon examination is a key finding in a threatened abortion. It indicates that the uterus is not yet dilating or effacing, suggesting that the pregnancy might still be maintained. Cervical dilation signifies progression towards abortion.
Choice C rationale
Mild to moderate lower abdominal cramping is a common symptom of a threatened abortion. These cramps result from uterine irritability and contractions as the body reacts to potential pregnancy loss. The intensity is less severe than in later stages of abortion.
Choice D rationale
Passage of fetal tissue is a definitive sign of an incomplete or complete abortion, meaning the pregnancy has already been lost and the products of conception are being expelled. This would not be expected in a threatened abortion.
Choice E rationale
Bright red vaginal bleeding is a common symptom of a threatened abortion, indicating disruption at the decidual-trophoblastic interface. The bleeding can range from spotting to light bleeding and suggests a potential threat to the pregnancy.

Choice A rationale: Assist the patient onto her left side

Positioning the patient on her left side helps improve uteroplacental blood flow by reducing compression of the inferior vena cava. This can enhance oxygen delivery to the fetus and mitigate late decelerations.

Choice B rationale: Assist with a vaginal exam for cord prolapse

Cord prolapse occurs when the umbilical cord slips ahead of the presenting fetal part, leading to variable decelerations rather than late decelerations. Since late decelerations indicate placental insufficiency rather than cord prolapse, this intervention is not necessary.

Choice C rationale: Discontinue the oxytocin infusion

Oxytocin is used to stimulate contractions, but excessive contractions can lead to uteroplacental insufficiency, causing late decelerations. Discontinuing oxytocin reduces uterine stress and improves fetal oxygenation.

Choice D rationale: Administer oxygen at 10 L/min via nonrebreather face mask

Providing high-flow oxygen increases maternal oxygenation, which in turn enhances fetal oxygen delivery. This intervention is a standard response to late decelerations.

Choice E rationale: Notify the health care provider

Late decelerations suggest fetal distress due to uteroplacental insufficiency, requiring urgent evaluation and possible escalation of care, such as intrauterine resuscitation or expedited delivery.

Choice F rationale: Stop the magnesium sulfate

Magnesium sulfate is administered for seizure prevention in preeclampsia and does not directly contribute to late decelerations. Therefore, stopping magnesium sulfate is not necessary in this situation.

Choice A rationale

Persistent feelings of sadness that are pervasive and interfere with daily functioning, coupled with severe fatigue that goes beyond typical postpartum tiredness and a marked loss of interest in activities, including bonding and caring for the newborn, are key indicators of postpartum depression. These symptoms are more intense and prolonged than the emotional lability often seen in the postpartum period.

Choice B rationale

Feeling anxious about the baby's well-being is a common experience for many postpartum individuals as they adjust to parenthood. As long as this anxiety does not impair their ability to care for the baby effectively, it is more likely a component of normal postpartum adjustment rather than indicative of postpartum depression.

Choice C rationale

Experiencing occasional mood swings and irritability is typical during the postpartum period due to hormonal shifts, sleep deprivation, and the significant life changes associated with a new baby. These fluctuations are usually transient and less severe than the persistent sadness and loss of interest seen in postpartum depression.

Choice D rationale

Feeling overwhelmed and having difficulty sleeping are common challenges for new parents due to the demands of newborn care. While these symptoms can contribute to or exacerbate postpartum depression, they are not solely indicative of it unless accompanied by persistent sadness, severe fatigue, and a loss of interest in activities.