Exhibits

A nurse is reviewing the medical record of a client who has a history of coronary artery disease. The nurse should identify which of the following as a risk factor? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

The client at 10 weeks gestation presents with abdominal cramping, moderate bright red vaginal bleeding, and an open cervix. These findings are classic indicators of a spontaneous abortion, particularly an inevitable abortion, in which pregnancy loss is in progress and cannot be prevented. Recognizing the significance of cervical dilation in the presence of bleeding is essential for prompt intervention, emotional support, and prevention of complications such as hemorrhage or infection.

Rationale for correct choices:

• Spontaneous abortion: This refers to the unintentional loss of pregnancy before 20 weeks gestation. The combination of abdominal cramping, moderate bright red vaginal bleeding, and an open cervix strongly suggests that the pregnancy is actively being expelled. Cervical dilation is particularly important because it differentiates threatened abortion from inevitable abortion. These findings indicate that the pregnancy is unlikely to continue and require close monitoring and supportive care.

• Cervical dilation: An open cervix during early pregnancy bleeding is a hallmark finding of inevitable spontaneous abortion. Cervical dilation indicates that the body is actively progressing toward expulsion of the products of conception. In threatened abortion, the cervix remains closed despite bleeding and cramping. Therefore, the presence of cervical dilation is the most clinically significant finding supporting the diagnosis of spontaneous abortion in this client.

Rationale for incorrect choices:

• Molar pregnancy: This is an abnormal gestation characterized by excessive trophoblastic tissue growth and markedly elevated hCG levels. Clients often present with uterine enlargement greater than expected for gestational age, severe nausea and vomiting, and passage of grape-like vesicles. This client’s hCG level is low-positive rather than excessively elevated, making molar pregnancy unlikely. The assessment findings are more consistent with pregnancy loss than trophoblastic overgrowth.

• Ectopic pregnancy: An ectopic pregnancy occurs when the fertilized ovum implants outside the uterus, most commonly in the fallopian tube. A history of recurrent chlamydia infections does increase ectopic pregnancy risk because pelvic inflammatory disease can scar the fallopian tubes. However, the open cervix is more characteristic of spontaneous abortion than ectopic pregnancy. Ectopic pregnancy more commonly presents with unilateral pelvic pain, adnexal tenderness, and possible signs of internal bleeding.

• hCG levels: The hCG level of 30 IU/L is only minimally positive and does not specifically identify the type of pregnancy complication occurring. While abnormal hCG trends can suggest nonviable pregnancy, a single low-positive result is less diagnostic than physical findings such as cervical dilation. In molar pregnancy, hCG levels are usually dramatically elevated rather than low.

• History of chlamydia infections: A history of recurrent chlamydia infections is a major risk factor for ectopic pregnancy because chronic inflammation may damage the fallopian tubes. However, this finding does not best explain the client’s current presentation of vaginal bleeding with an open cervix. The physical evidence of cervical dilation directly supports spontaneous abortion rather than ectopic implantation. Risk factors are important, but current clinical findings take priority in determining the most likely condition.

Blood glucose monitoring is a routine nursing procedure used to assess a client’s glycemic status and guide diabetes management. Accurate capillary blood sampling technique is essential to obtain reliable results while minimizing discomfort and tissue injury. Proper procedure also reduces the risk of infection and ensures adequate blood flow from the puncture site. Nursing care focuses on correct site selection, aseptic technique, and avoiding actions that may distort results.

Rationale:
A. Puncturing the side of the client’s finger is correct because this area has fewer nerve endings and is less painful compared to the fingertip center. It also provides adequate capillary blood flow for accurate glucose measurement. Proper site selection improves client comfort while ensuring reliable results during monitoring of conditions such as Blood glucose monitoring.

B. Positioning the client’s finger above the heart is incorrect because it reduces blood flow to the puncture site, making it more difficult to obtain an adequate blood sample. The finger should be kept in a dependent position or gently warmed to promote capillary perfusion. Elevation may lead to insufficient sample collection and repeated punctures.

C. Milking the finger site is incorrect because it can cause tissue fluid contamination of the blood sample, leading to falsely altered glucose readings. Excessive squeezing may dilute the sample with interstitial fluid, reducing accuracy. Gentle pressure may be used, but forceful “milking” should be avoided.

D. Applying sterile gloves is not required for routine blood glucose monitoring; clean gloves are appropriate. The procedure is considered non-sterile but requires standard precautions to prevent infection. Using sterile gloves unnecessarily increases cost and is not indicated for capillary blood sampling.