The nurse has reviewed the Nurses' Notes from 5 days ago.

The nurse is providing discharge teaching to the client. Select the 3 statements the nurse should make.

Rationale for correct choices

• Spontaneous abortion: The client is at 10 weeks gestation with vaginal bleeding, abdominal cramping, and an open cervix, which are classic findings associated with spontaneous abortion. The presence of cervical dilation indicates that pregnancy loss is actively occurring or imminent. These findings distinguish spontaneous abortion from other early pregnancy complications.

• Cervical dilation: Cervical dilation during early pregnancy is a key indicator of pregnancy loss. In spontaneous abortion, the cervix opens as products of conception begin to pass. This finding provides objective evidence that the pregnancy is not being maintained.

Rationale for incorrect choices

• Molar pregnancy: Molar pregnancy is associated with excessively high hCG levels, uterine enlargement greater than gestational age, and symptoms such as severe nausea or hyperemesis. The client’s hCG level is appropriate for gestational age and does not suggest trophoblastic overgrowth. Cervical dilation is not a defining feature of molar pregnancy.

• Ectopic pregnancy: Ectopic pregnancy typically presents with unilateral pelvic pain, possible shoulder pain, and often no cervical dilation. Vaginal bleeding may occur, but the cervix usually remains closed. Additionally, ectopic pregnancies often have lower-than-expected hCG levels.

• Lower abdominal cramping: Abdominal cramping is a common symptom in many early pregnancy complications and is not specific to spontaneous abortion. While it supports uterine activity, it does not independently confirm pregnancy loss. Cervical dilation provides stronger diagnostic evidence. Cramping alone is insufficient as the primary indicator.

• hCG levels: The client’s hCG level is within the expected range for 10 weeks gestation. Abnormally high levels would suggest molar pregnancy, while low or slowly rising levels might suggest ectopic pregnancy or nonviable gestation. In this case, hCG does not explain the acute findings.

A. "I should ask the provider to write a prescription for mechanical restraints as needed.": Prescriptions for restraints must specify a time-limited duration and cannot be written as “as needed.” This ensures that the use of restraints is justified, monitored, and reevaluated according to legal and regulatory standards.

B. "I should assess the client's skin integrity every 8 hours while in mechanical restraints.": Skin integrity should be assessed much more frequently—typically every 2 hours—to prevent pressure injuries, skin breakdown, and circulation issues associated with prolonged restraint use.

C. "I should expect the provider to evaluate the client within 4 hours of restraint application.": For adults, the provider must evaluate the client within 1 hour of initiating restraints. Waiting 4 hours would not meet safety or regulatory requirements for ongoing assessment.

D. "I should visually monitor the client continuously when in mechanical restraints.": Continuous visual monitoring is essential to ensure client safety, detect signs of distress, monitor for respiratory compromise, and prevent injury while the restraints are in place.