A nurse in an ambulatory surgery center is providing discharge teaching to a client who had a dilation and curettage (D&C) following a spontaneous miscarriage.
Which of the following should be included in the teaching?
Vaginal intercourse can be resumed after 2 weeks.
Increased intake of zinc-rich foods is recommended.
Aspirin may be taken for cramps.
Products of conception will be present in vaginal bleeding.
The Correct Answer is A
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. .
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"B"}
Explanation
The condition that poses the greatest risk to the newborn is meconium aspiration syndrome due to amniotic fluid.
Rationale for correct answers
Meconium aspiration syndrome (MAS) occurs when a newborn inhales meconium-stained amniotic fluid, leading to airway obstruction, chemical pneumonitis, and surfactant dysfunction. The presence of dark brown-greenish amniotic fluid, along with mild respiratory distress (nasal flaring, increased respiratory rate of 60/min), raises concern for MAS. Close monitoring for worsening respiratory symptoms is essential.
Amniotic fluid contamination with meconium increases the risk of lung inflammation and infection. The newborn’s vigorous condition suggests mild aspiration, but continuous observation is needed.
Rationale for incorrect Response 1 options
- Jaundice: While term newborns may develop physiological jaundice, there are no indications of hyperbilirubinemia or hemolysis in this case.
- Hypoglycemia: No jitteriness or poor feeding, and birth weight is within normal range; hypoglycemia more commonly affects preterm or low birth weight infants.
- Cold stress: The newborn is under a radiant warmer, and temperature is within normal range (36.5°C).
Rationale for incorrect Response 2 options
- Birth weight: No signs of growth restriction or macrosomia-associated complications.
- Acrocyanosis: Normal in newborns due to immature circulation, not an indicator of respiratory compromise.
- Apgar scores: Strong Apgar scores (8 and 9) suggest good adaptation to extrauterine life.
Correct Answer is C
Explanation
Choice A rationale
Limiting the newborn's intake of milk is contraindicated in the treatment of hyperbilirubinemia. Adequate hydration and frequent feedings are essential to promote bilirubin excretion through stool and urine. Decreased intake can exacerbate dehydration and worsen jaundice. Normal feeding frequency for newborns is typically every 2-3 hours.
Choice B rationale
Feeding the newborn every six hours is not an appropriate intervention for a jaundiced infant receiving phototherapy. Frequent feedings, typically every 2-3 hours, are necessary to promote bilirubin excretion. Prolonged intervals between feedings can lead to dehydration and hinder the effectiveness of phototherapy.
Choice C rationale
Turning the infant every two hours is a crucial nursing intervention during phototherapy. This ensures that all body surfaces are exposed to the ultraviolet light, maximizing the breakdown of bilirubin in the skin. Consistent exposure of all areas helps to lower bilirubin levels more effectively.
Choice D rationale
Applying an oil-based lotion to the newborn's skin during phototherapy is contraindicated. Oil-based lotions can create a barrier on the skin, reducing the penetration and effectiveness of the ultraviolet light. Only water-based lotions, if necessary, should be used sparingly and with caution, as some may absorb UV light.
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