A nurse is reinforcing nutrition teaching with a client during the first prenatal visit. Which of the following statements by the client indicates understanding of the teaching?

Choice A:

While an ultrasound can indeed determine if there are multiple fetuses, this is not the primary reason for performing it prior to amniocentesis. The number of fetuses is typically established earlier in pregnancy through routine ultrasounds.

Focusing solely on multiple fetuses might lead the client to believe that ultrasounds are only conducted in such cases, which is not accurate.

Choice B:

Determining fetal age is a crucial aspect of prenatal care, but it's not the main reason for an ultrasound before amniocentesis. Fetal age is typically assessed through earlier ultrasounds, often in the first trimester.

Highlighting fetal age might misinform the client about the specific purpose of the ultrasound in this context.

Choice C:

This is the most appropriate response because it accurately identifies the primary purpose of the ultrasound.

Amniocentesis involves inserting a needle into the amniotic sac to collect a sample of amniotic fluid. To ensure the safety of the procedure and minimize risks to the fetus, it's essential to accurately visualize the location of the amniotic sac and placenta, as well as assess the position of the fetus.

Ultrasound provides real-time imaging that allows the healthcare provider to visualize these structures with precision, guiding the needle insertion and reducing the risk of complications.

Choice D:

While stating that the ultrasound is for imaging is technically correct, it's too general and doesn't provide the specific reason for its use in this context.

A more informative response would clarify the specific imaging goals for amniocentesis, as outlined in Choice C.

Choice A rationale:

Premature maturity is not a plausible cause of bleeding without contractions at 1 week of pregnancy. Premature maturity, or preterm labor, refers to labor that begins before 37 weeks of gestation. It is characterized by contractions and cervical changes, often accompanied by other symptoms such as lower back pain, pelvic pressure, or a change in vaginal discharge. At 1 week of pregnancy, the fetus is still in the very early stages of development, and premature labor is not possible.

Choice C rationale:

The location of the placenta can sometimes cause bleeding in pregnancy, but it is typically associated with later stages of gestation, such as the second or third trimester. Placental conditions like placenta previa, where the placenta lies low in the uterus and partially or completely covers the cervix, can lead to bleeding, but this is unlikely to occur at 1 week of pregnancy. Moreover, placenta previa is usually accompanied by pain or cramping, which is not present in the client's case.

Choice D rationale:

The frequency and duration of contractions are relevant in assessing labor progression, but they are not a primary cause of bleeding without contractions. Contractions are the rhythmic tightening and relaxing of the uterine muscles that help to dilate the cervix and move the baby through the birth canal. Bleeding without contractions at 1 week of pregnancy suggests a different underlying issue.

Choice B rationale:

Incompetency, also known as cervical insufficiency or cervical incompetence, is the most likely cause of bleeding without contractions at 1 week of pregnancy. It occurs when the cervix is weak and begins to open prematurely, even without the presence of contractions. This can lead to bleeding and potential miscarriage or preterm birth. The fact that the client can feel the baby moving does not rule out cervical insufficiency, as fetal movement can sometimes be felt as early as 13-16 weeks of pregnancy.