A nurse is caring for a client at a 10-week prenatal visit. The provider diagnoses the client with a missed spontaneous abortion confirmed by ultrasound and the nurse is discussing the plan of care with the client.
Which of the following statements should the nurse make?
"It can be helpful to talk about your loss with others who have experienced a pregnancy loss.”.
"Once the fetus is passed, the provider will likely be able to determine what caused the pregnancy loss.”.
"I have found that it is best to avoid seeing the fetal remains after the procedure.”.
"It is okay to feel some grief now, even though it is so early in the pregnancy for a loss.”.
Correct Answer : A,D
Choice A rationale
Providing an opportunity to connect with others who have experienced similar losses offers significant psychosocial support. Sharing experiences can normalize grief, reduce feelings of isolation, and validate emotions. This peer support can facilitate the grieving process by fostering a sense of community and understanding during a challenging time.
Choice B rationale
While some causes of spontaneous abortion can be identified, many remain unknown even after the expulsion of fetal tissue. Genetic anomalies, chromosomal abnormalities, or uterine factors are often implicated, but a definitive cause is not always determined. Providing this information can create unrealistic expectations and potential disappointment for the client.
Choice C rationale
The decision to view fetal remains is highly personal and depends on individual coping mechanisms and cultural beliefs. For some, it can be a crucial part of acknowledging the loss and beginning the grieving process. Advising against it prematurely removes a potential avenue for closure and validation for the client.
Choice D rationale
Validating the client's grief, regardless of the gestational age, is crucial for emotional well-being. Acknowledging that it is "okay to feel some grief now" provides permission for the client to experience their emotions. Grief is a subjective process, and the intensity and duration are not dictated by the length of the pregnancy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D"]
Explanation
Choice A rationale
Temperature instability, particularly hypothermia, is a significant indicator of neonatal hypoglycemia. Glucose is the primary metabolic fuel for thermogenesis, and its deficiency impairs the infant's ability to maintain core body temperature. The normal newborn temperature range is typically 36.5°C to 37.5°C (97.7°F to 99.5°F).
Choice B rationale
Acrocyanosis, a bluish discoloration of the hands and feet, is a common and usually benign finding in newborns, especially in the first 24-48 hours, due to immature peripheral circulation. It does not directly indicate hypoglycemia; rather, it reflects normal physiological adaptation to extrauterine life.
Choice C rationale
Jitteriness, or tremors, is a classic neurological sign of hypoglycemia in newborns. The central nervous system is highly dependent on glucose for energy, and insufficient glucose supply can lead to neuronal excitability and involuntary muscle movements. This is often an early and prominent symptom.
Choice D rationale
Hypotonia, characterized by decreased muscle tone and floppiness, can be a symptom of severe or prolonged hypoglycemia. Glucose is essential for proper neuromuscular function, and its deprivation can impair nerve impulse transmission and muscle contraction, leading to reduced muscle resistance to passive movement.
Choice E rationale
Abdominal distention is typically associated with gastrointestinal issues such as feeding intolerance, bowel obstruction, or necrotizing enterocolitis. It is not a direct or common manifestation of hypoglycemia in newborns. Hypoglycemia primarily affects metabolic and neurological systems.
Correct Answer is C
Explanation
Choice A rationale
Immediate cesarean birth is generally not indicated for intrauterine fetal demise unless there are maternal complications, such as hemorrhage or infection, or if the client has a prior uterine scar that contraindicates vaginal birth. Cesarean section carries higher risks for the mother compared to vaginal delivery and is usually reserved for specific obstetrical indications.
Choice B rationale
Methotrexate is an antimetabolite medication primarily used in the management of ectopic pregnancy or gestational trophoblastic disease due to its cytotoxic effects on rapidly dividing cells. It is not indicated for the induction of labor or expulsion of a fetus in cases of intrauterine fetal demise as it does not stimulate uterine contractions effectively for this purpose.
Choice C rationale
In cases of intrauterine fetal demise at 36 weeks of gestation, scheduled induction of labor is the most common and generally recommended treatment option. This approach allows for planned delivery, reduces the psychological burden of carrying a deceased fetus, and minimizes the risk of complications such as coagulopathy for the mother, typically occurring after prolonged retention.
Choice D rationale
Dilation with suction curettage is a procedure typically used for early pregnancy termination or management of miscarriage in the first or early second trimester. At 36 weeks of gestation, the size of the fetus and uterus makes this procedure unsafe and inappropriate for delivery of a deceased fetus, posing significant risks of uterine perforation or hemorrhage.
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