A nurse is reviewing the electronic health record (EHR) of a client who has a diagnosis of an inevitable abortion.
Which of the following findings should the nurse identify as a contraindication to a medical intervention?
Manifestations of an infection.
Intermittent bleeding.
History of a bleeding disorder.
Report of intense pain.
Anemia present in the client.
Correct Answer : A,C,E
Choice A rationale
In the context of an inevitable abortion, the presence of an infection such as chorioamnionitis or sepsis is a major contraindication to certain medical interventions like expectant management. Infection requires immediate stabilization with broad-spectrum antibiotics and prompt evacuation of the uterus to prevent systemic inflammatory response syndrome. Normal white blood cell counts range from 5,000 to 10,000 cells/mm; elevations significantly above this indicate an active inflammatory process that necessitates urgent surgical rather than medical pathways.
Choice B rationale
Intermittent bleeding is an expected clinical manifestation of an inevitable abortion and is not a contraindication to medical intervention. The process involves the cervical os dilating and the products of conception beginning to detach, which naturally results in varying degrees of hemorrhage. As long as the patient remains hemodynamically stable and the bleeding is not excessive, medical management or observation can continue. It does not preclude the use of medications to assist the process.
Choice C rationale
A history of a bleeding disorder, such as von Willebrand disease or hemophilia, is a contraindication to medical management of an abortion because medications like misoprostol can cause heavy uterine contractions and significant blood loss. Without normal clotting factors, the client is at extreme risk for life-threatening hemorrhage during the expulsion of the products of conception. Such cases usually require a controlled surgical environment where hemostasis can be more effectively managed and monitored by the surgical team.
Choice D rationale
Intense pain is a subjective symptom frequently associated with the uterine contractions and cervical dilation occurring during an inevitable abortion. While pain management is a priority for nursing care, the presence of pain itself does not contraindicate medical interventions. In fact, medical management aims to complete the process that is causing the pain. Pain should be assessed using standardized scales and treated appropriately with analgesics while the medical or surgical intervention proceeds.
Choice E rationale
Anemia is a contraindication to medical management because the process of expelling the products of conception often involves significant blood loss. A client with a baseline low hemoglobin, typically defined as less than 11 g/dL in pregnancy, has less physiological reserve to tolerate further hemorrhage. Medical interventions that may prolong bleeding increase the risk of the client requiring a blood transfusion or developing hypovolemic shock, making surgical evacuation a safer, more definitive option.
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Related Questions
Correct Answer is C
Explanation
Choice A rationale
Fibroids are benign growths of the smooth muscle of the uterus, also known as leiomyomas. While they can cause symptoms similar to endometriosis, such as pelvic pain and heavy menstrual bleeding, they are a distinct pathological condition involving the myometrium. Endometriosis involves the growth of endometrial-like tissue outside the uterine cavity. Therefore, the presence of fibroids does not confirm a diagnosis of endometriosis, though a patient could potentially suffer from both conditions simultaneously.
Choice B rationale
Mastalgia refers to breast pain, which can be cyclical and related to hormonal changes during the menstrual cycle. While women with endometriosis often experience significant hormonal fluctuations and pelvic pain, breast pain is not a diagnostic hallmark or a specific clinical indicator of endometriosis. Endometriosis is characterized by ectopic endometrial tissue, primarily affecting the pelvic organs, and its primary symptoms are localized to the lower abdomen, pelvis, and the reproductive tract.
Choice C rationale
Infertility is a very common complication and clinical finding in women with endometriosis, affecting approximately 30 to 50 percent of individuals with the condition. The presence of ectopic endometrial tissue causes chronic inflammation, adhesions, and scarring that can distort pelvic anatomy and obstruct the fallopian tubes. Additionally, the inflammatory environment can negatively impact egg quality and the implantation process. Finding that a client is struggling to conceive often leads to an investigation for endometriosis.
Choice D rationale
Ovarian cysts are fluid-filled sacs that can develop for many reasons, including normal ovulation. While a specific type of cyst known as an endometrioma or chocolate cyst is associated with endometriosis, not all ovarian cysts indicate this disease. Functional cysts like follicular or corpus luteum cysts are very common and unrelated to endometriosis. Therefore, the general finding of an ovarian cyst is too non-specific to support a definitive diagnosis of endometriosis without further histological confirmation.
Correct Answer is C
Explanation
Choice A rationale
Hyperventilation in pregnancy is often a compensatory mechanism due to increased progesterone levels stimulating the respiratory center, but it does not explain the sudden relief in breathing described by the client. Hyperventilation usually causes a decrease in arterial carbon dioxide levels and can lead to dizziness or tingling. The client's description specifically points to a mechanical change in the physical capacity of the lungs rather than a change in respiratory rate.
Choice B rationale
Decreased carbon dioxide production does not occur at the end of pregnancy; in fact, maternal basal metabolic rate and oxygen consumption increase significantly to support the fetus and placenta. The feeling of being able to breathe better is not related to chemical changes in gas production but rather to the physical relocation of the fetus. The total metabolic demand on the maternal system remains high until delivery, maintaining a steady need for gas exchange.
Choice C rationale
Lightening occurs when the fetal presenting part descends into the true pelvis, which typically happens a few weeks before labor in primigravidas. This descent reduces the upward pressure of the uterus on the diaphragm, allowing for greater lung expansion and easier breathing. While this provides respiratory relief, it often increases pressure on the urinary bladder, leading to increased urinary frequency and changes in the maternal gait due to the shifting center of gravity.
Choice D rationale
Decreasing chest diameter would actually impair the client's ability to breathe rather than improve it. During pregnancy, the chest diameter typically increases as the rib cage flares outward to accommodate the growing uterus and the displaced diaphragm. A decrease in chest diameter is not a physiological occurrence at thirty-nine weeks of gestation. The sensation of improved breathing is strictly due to the fetus moving lower, not the rib cage becoming smaller.
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