A nurse in a prenatal clinic is teaching a client who has a new prescription for dinoprostone (Cervidil) gel. Which of the following statements should the nurse include in the teaching?

The correct answer is: c. 42022

Choice A: 40122

Reason: This choice is incorrect because it indicates 4 pregnancies (correct), 0 term births (correct), 1 preterm birth (correct), 2 abortions (correct), but 2 living children (incorrect). The client has 2 living children, which is correct, but the term and preterm counts are not accurate.

Choice B: 20020

Reason: This choice is incorrect because it indicates 2 pregnancies (incorrect), 0 term births (correct), 0 preterm births (incorrect), 2 abortions (correct), and 0 living children (incorrect). The client has had 4 pregnancies, 1 preterm birth, and 2 living children.

Choice C: 42022

Reason: This choice is correct. It indicates 4 pregnancies (current pregnancy, elective abortion, twins, spontaneous abortion), 0 term births, 2 preterm births (twins at 36 weeks), 2 abortions (elective at 9 weeks, spontaneous at 15 weeks), and 2 living children (twins).

Choice D:

The GTPAL system is used to assess a client's obstetric history:

• G (Gravida): The total number of pregnancies, including the current one.
• T (Term births): The number of pregnancies carried to at least 37 weeks.
• P (Preterm births): The number of pregnancies delivered between 20 and 36 weeks, 6 days.
• A (Abortions): The number of pregnancies ending before 20 weeks (spontaneous or elective).
• L (Living children): The number of children currently alive.

For this client:

G (Gravida): 4 (one elective abortion, one twin pregnancy, one spontaneous abortion, and the current pregnancy).

• T (Term births): 0 (the twin pregnancy was delivered at 36 weeks, which is preterm).
• P (Preterm births): 1 (twins delivered at 36 weeks count as one preterm birth).
• A (Abortions): 2 (one elective abortion at 9 weeks, one spontaneous abortion at 15 weeks).
• L (Living children): 2 (the twins).

Thus, the GTPAL for this client is 4-0-1-2-2.

A) Retained bile in the liver results in delayed digestion: This statement is not related to the cause of heartburn.
B) Increased estrogen production causes increased secretion of hydrochloric acid: While hormonal changes during pregnancy can contribute to heartburn, it is specifically increased progesterone that leads to relaxation of the cardiac sphincter and delayed gastric emptying, which are more directly linked to heartburn.
C) Pressure from the growing uterus displaces the stomach: Uterine pressure on the stomach can lead to a feeling of fullness, but it is not the primary cause of heartburn during pregnancy.
D) Increased progesterone production causes relaxation of the smooth muscle relaxation of the cardiac sphincter and delayed gastric emptying: This is the correct answer. Increased progesterone levels during pregnancy relax the lower esophageal sphincter, leading to gastric acid reflux into the esophagus and causing heartburn.