A woman presents to the clinic in the first trimester of pregnancy.

She has three children living at home.

One of them was born prematurely at 34 weeks.

The other two were full-term at birth.

She has a history of one miscarriage.

How do you record her obstetric history on the chart using GTPAL format?

Choice A rationale

An alpha-fetoprotein (AFP) test is a blood test that measures the levels of AFP in the maternal serum. This test does not require any specific dietary restrictions, such as fasting. Therefore, advising the client to abstain from food or drink for 8 hours before the test is not based on physiological necessity for accurate AFP measurement.

Choice B rationale

Test results are influenced by various factors, including gestational age, multiple pregnancies, and certain fetal anomalies. While chronic illnesses can impact overall health, they do not directly determine the outcome of an AFP screening test, which primarily assesses the risk of neural tube defects or chromosomal abnormalities.

Choice C rationale

An AFP test is a simple blood draw and is not an invasive procedure. Therefore, there is no physiological need for bed rest following the test. Clients can resume their normal activities immediately after the blood sample is collected, as there are no associated post-procedure complications requiring immobility.

Choice D rationale

The AFP test is a screening tool, meaning it identifies individuals who may be at an increased risk for certain conditions, such as neural tube defects or Down syndrome. It does not provide a definitive diagnosis. Abnormal screening results necessitate further diagnostic testing, such as amniocentesis or high-resolution ultrasound, for confirmation.

Choice A rationale

Restraining a child with autism can exacerbate distress and lead to further agitation due to sensory overload and a feeling of loss of control. Physical restraint can activate the sympathetic nervous system, increasing heart rate and cortisol levels, which can traumatize the child and hinder therapeutic rapport, contravening principles of trauma-informed care.

Choice B rationale

Hand flapping and rocking are common self-stimulatory behaviors, or "stimming," in children with autism, serving to regulate sensory input and manage anxiety. Allowing these behaviors in a low-stimulus environment supports emotional regulation by reducing external stressors and promoting a sense of security, which is crucial for individuals with sensory processing differences.

Choice C rationale

Immediately redirecting or attempting to stop self-stimulatory behaviors can be counterproductive for a child with autism. These behaviors often serve a vital self-regulatory function; interrupting them without providing an alternative coping mechanism can increase anxiety, frustration, and escalate behavioral challenges, disrupting their internal equilibrium.

Choice D rationale

Engaging in verbal interaction to distract a child with autism during self-soothing can disrupt their regulatory process. Children with ASD often have difficulties with social communication and may find unexpected verbal input overwhelming, potentially increasing sensory overload and agitation, rather than providing effective distraction or comfort.