The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse expect to observe? (Select all that apply)

Choice A reason: Genetic changes and anomalies are not the most dangerous effect, as they are rare and not directly caused by smoking. Smoking can increase the risk of some birth defects, such as cleft lip and cleft palate, but these are not genetic changes and can be corrected by surgery. Smoking can also cause chromosomal abnormalities in the eggs, but these usually result in miscarriage or stillbirth, not live births.

Choice B reason:Maternal smoking is a significant risk factor for intrauterine growth restriction (IUGR). Nicotine and carbon monoxide from cigarettes reduce oxygen supply to the fetus, leading to lower birth weights and smaller body lengths.

Choice C reason: Fetal addiction to the substance inhaled is not the most dangerous effect, as it is not permanent and can be treated by medication and supportive care. Smoking can expose the fetus to nicotine, carbon monoxide, and other harmful chemicals, which can cross the placenta and affect the fetal brain and nervous system. Smoking can also cause withdrawal symptoms in the newborn, such as irritability, tremors, and difficulty feeding.

Choice D reason:Although prenatal exposure to smoking can affect neurodevelopment and is associated with behavioral issues, extensive central nervous system damage is not the most immediate or dangerous effect. The most critical concern remains intrauterine growth restriction.

Choice A reason: Asking the woman to reschedule the appointment for the examination is not the best response, as it may delay the detection and treatment of any potential problems. The nurse should inform the woman about the possible effect of the vaginal cream on the Pap test and offer her the option to reschedule or proceed with the examination.

Choice B reason: Asking the woman to describe the symptoms that indicate to her that she has a vaginal infection is a good way to assess the woman's condition and provide education, but it is not the initial response. The nurse should first inform the woman about the possible effect of the vaginal cream on the Pap test and then ask her about her symptoms.

Choice C reason: Reassuring the woman that using vaginal cream is not a problem for the examination is not true, as vaginal creams can alter the pH of the vaginal environment and affect the accuracy of the Pap test. The nurse should inform the woman about the possible effect of the vaginal cream on the Pap test and explain the importance of avoiding vaginal creams, douches, or intercourse for 48 hours before the test.

Choice D reason: Informing the woman that vaginal creams may interfere with the Pap test for which she is scheduled is the best response, as it educates the woman about the purpose and procedure of the Pap test and allows her to make an informed decision about whether to reschedule or proceed with the examination. The nurse should also explain the risks and benefits of both options and respect the woman's choice.