A nurse is formulating a care plan for a patient who is 10 weeks pregnant and reports abdominal pain and moderate vaginal bleeding.
The preliminary diagnosis is an inevitable abortion.
Which nursing interventions should be included in the care plan?
Maintain the patient on bed rest.
Offer the option to view products of conception.
Administer oxygen via a nasal cannula.
Instruct the patient to increase potassium-rich foods in the diet.
The Correct Answer is A
Choice A rationale
Maintain the patient on bed rest. This is a common nursing intervention for a patient who is experiencing an inevitable abortion. Bed rest can help reduce the risk of further complications, such as heavy bleeding. It can also provide the patient with a chance to rest and recover physically and emotionally.
Choice B rationale
Offer the option to view products of conception. This intervention may not be appropriate for all patients. While some patients may find it helpful to view the products of conception, others may find it distressing. It’s important to discuss this option with the patient and respect her wishes.
Choice C rationale
Administer oxygen via a nasal cannula. This intervention may not be necessary for all patients experiencing an inevitable abortion. While oxygen therapy can be used to treat hypoxia in patients with heavy bleeding, it’s not typically required unless the patient shows signs of hypoxia.
Choice D rationale
Instruct the patient to increase potassium-rich foods in the diet. This intervention is not typically part of the care plan for a patient experiencing an inevitable abortion. While a balanced diet is important for overall health, there’s no specific need to increase potassium-rich foods in the diet in this situation.
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Related Questions
Correct Answer is A
Explanation
Choice A rationale
Moderate exercise improves circulation. This statement is accurate and should be included in the teaching. Regular moderate exercise during pregnancy can have many benefits, including improved circulation, which can help reduce swelling and varicose veins. It can also help manage weight gain, improve mood and energy levels, reduce pregnancy discomfort, prepare the body for labor, and boost stamina for labor and delivery.
Choice B rationale
Refrain from exercises that include stretching. This statement is not accurate and should not be included in the teaching. Stretching exercises can be beneficial during pregnancy. They can help improve flexibility, reduce muscle tension, alleviate pregnancy discomfort, and prevent muscle imbalances. However, pregnant women should be careful not to stretch too far, as the hormones produced during pregnancy can make the ligaments more flexible and easier to stretch, increasing the risk of injuries.
Choice C rationale
It is recommended to rest for 30 minutes before each new exercise. This statement is not accurate and should not be included in the teaching. While it’s important for pregnant women to rest and avoid overexertion, there’s no specific recommendation to rest for 30 minutes before each new exercise. Instead, pregnant women should listen to their bodies and rest as needed.
Choice D rationale
It is recommended to increase your weight-bearing exercises. This statement is not accurate and should not be included in the teaching. While weight-bearing exercises can be beneficial, they should be done with caution during pregnancy. Pregnant women should avoid heavy weights and exercises that put pressure on the joints, increase the risk of injury, or cause discomfort. Instead, they should focus on exercises that strengthen the muscles and improve balance and flexibility.
Correct Answer is D
Explanation
The correct answer is Choice D
Choice A rationale: Lanugo, very fine hairs, begin to cover the baby's body around week 20, not week 36. These hairs help protect the skin and usually disappear before birth. By week 36, the lanugo has mostly disappeared, and the baby is almost fully developed.
Choice B rationale: The sex of the baby is determined at conception based on the chromosomes carried by the sperm and egg. However, the external genitalia do not become distinguishable until around week 12 of pregnancy, making week 8 too early for sex determination.
Choice C rationale: Most women first feel fetal movements, known as quickening, between weeks 18 and 22, not week 24. This can vary based on individual factors, but week 24 is generally later than the typical range for first fetal movements.
Choice D rationale: The baby's heartbeat can usually be heard using a Doppler stethoscope by around 12 weeks of pregnancy. This marks a significant milestone and reassures expectant parents about their baby's health and development at this early stage
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