A client receives abnormal genetic test results and becomes visibly upset. What is the nurse's best initial response?
Provide detailed medical explanations
Refer immediately without discussion
Actively listen and provide emotional support
Avoid discussing results
The Correct Answer is C
Effective communication in genetic counseling requires an empathetic approach to address the psychological impact of adverse findings. Patients often experience a "crisis of meaning" or grief when receiving news of fetal anomalies. The nurse’s role is to facilitate emotional regulation before moving toward complex decision-making processes.
A. Provide detailed medical explanations: Delivering excessive technical data while a patient is in an acute emotional state often leads to information overload and increased anxiety. The patient’s cognitive processing is usually impaired by the stress response. Medical details should follow once the patient is emotionally stabilized.
B. Refer immediately without discussion: Abrupt referral can make the patient feel abandoned and ignores the immediate need for therapeutic intervention. While a genetic counselor is necessary, the nurse must first provide crisis support. Immediate referral without a supportive conversation is clinically dismissive.
C. Actively listen and provide emotional support: Allowing the patient to express feelings validates their experience and helps lower autonomic arousal. Providing a safe space for silence and tears is the priority nursing action in the face of psychological distress. This builds the rapport necessary for later education.
D. Avoid discussing results: Ignoring the situation or avoiding the topic is a non-therapeutic technique that increases the patient's sense of isolation. Failure to acknowledge the abnormal results hinders the informed consent process and delays necessary care. Nurses must be present and transparent during difficult disclosures.
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Related Questions
Correct Answer is B
Explanation
The management of preeclampsia at a pre-viable or early preterm gestation focuses on expectant management to allow for fetal growth. This involves close monitoring for maternal end-organ damage while maximizing the time the fetus remains in utero. The strategy balances maternal safety against the risks of neonatal prematurity.
A. Stop fetal growth: Preeclampsia often causes placental insufficiency, which may lead to intrauterine growth restriction (IUGR). However, the goal of medical care is to optimize perfusion and support growth, not to stop it. Fetal biophysical profiles are used to monitor growth.
B. Prolong pregnancy safely: At 28 weeks, the neonate faces significant morbidity from prematurity. Clinicians attempt to maintain the pregnancy to reach a more mature gestational age while blood pressure is controlled. Stabilization prevents acute maternal complications while the fetus gains weight.
C. Immediate delivery: Delivery is the only definitive cure for preeclampsia, but at 28 weeks, it is reserved only for "severe features" that are life-threatening. If the mother and fetus are stable, immediate delivery is avoided to prevent extreme neonatal complications. Delay allows for steroid administration.
D. Eliminate BP monitoring: Frequent blood pressure assessment is the most critical component of managing preeclampsia. Monitoring detects hypertensive crises and guides the administration of antihypertensive medications like labetalol. Eliminating this would lead to unmonitored vasospasm and stroke risk.
Correct Answer is D
Explanation
Pregestational diabetes requires intensive glycemic management to mitigate the risk of congenital anomalies and macrosomia. The physiological shift in insulin sensitivity during pregnancy necessitates frequent capillary blood glucose assessments to adjust insulin dosages precisely. Maintaining a tight euglycemic state is the primary goal of obstetric diabetic care.
A. Weekly: Monitoring once per week is insufficient to capture the dynamic fluctuations in blood sugar that occur throughout a single day. This frequency would lead to dangerous delays in identifying hyperglycemia or nocturnal hypoglycemia. It fails to meet the clinical standard for high-risk diabetic pregnancy management.
B. Once daily: A single daily check provides only a partial snapshot of metabolic control and ignores the impact of meals and activity levels. It does not allow for the titration of prandial insulin or the identification of fasting trends. This approach significantly increases the risk of poorly controlled maternal glucose.
C. Twice daily: Checking only twice per day misses critical postprandial peaks and late-night troughs that can affect fetal development. It provides inadequate data for a comprehensive insulin regimen adjustment. Effective management of pregestational diabetes requires much more granular data to ensure a healthy pregnancy outcome.
D. 4-6 times daily: Standard protocol involves checking fasting levels and 1 to 2 hours after each meal, often including a bedtime or 3:00 AM check. This frequency allows for immediate pharmacological corrections and dietary modifications based on real-time data. It is the necessary frequency to achieve target HbA1c levels safely.
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