A nurse is caring for a patient in the obstetric clinic that has made the difficult decision to terminate the pregnancy due to a confirmed genetic abnormality that is incompatible with life.Which of the following would be an appropriate nursing action?
Do not provide resources right now, as it may be too overwhelming.
Discuss the stages of grief they may experience.
Encourage them to rethink their decision.
Encourage the couple to not share their individual emotions with each other.
The Correct Answer is B
Choice A rationale
Not providing resources immediately may leave the patient feeling unsupported and isolated. It is important to offer resources and support to help the patient cope with the emotional and psychological impact of terminating a pregnancy due to a genetic abnormality.
Choice B rationale
Discussing the stages of grief is an appropriate nursing action. It helps the patient understand that their feelings are normal and provides a framework for processing their emotions. This support can be crucial in helping the patient navigate their grief and begin the healing process.
Choice C rationale
Encouraging the patient to rethink their decision is not appropriate. The decision to terminate a pregnancy due to a genetic abnormality is often difficult and deeply personal. It is important to respect the patient’s decision and provide support rather than questioning their choice.
Choice D rationale
Encouraging the couple not to share their emotions with each other can be harmful. Open communication between partners is essential for mutual support and understanding during such a challenging time. Encouraging them to share their feelings can strengthen their relationship and help them cope with the loss together.
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Correct Answer is C
Explanation
Choice A rationale
A blood transfusion just after delivery is not a standard intervention for a client with Rh-negative blood type. The primary concern for Rh-negative clients is the potential for Rh incompatibility with the fetus, which can lead to hemolytic disease of the newborn. This condition is prevented by administering RhO(D) immune globulin during pregnancy.
Choice B rationale
Maternal serum alpha-fetoprotein (MSAFP) testing is used to screen for certain fetal abnormalities, such as neural tube defects, but it is not specifically related to Rh incompatibility. The primary intervention for Rh-negative clients is the administration of RhO(D) immune globulin to prevent sensitization.
Choice C rationale
RhO(D) immune globulin is administered at around 28 weeks of gestation to prevent Rh sensitization in Rh-negative clients. This intervention is crucial for preventing the development of antibodies that could harm the fetus in current or future pregnancies.
Choice D rationale
A three-hour glucose tolerance test is used to screen for gestational diabetes, which is a separate concern from Rh incompatibility. The primary intervention for Rh-negative clients is the administration of RhO(D) immune globulin.
Correct Answer is C
Explanation
Choice A rationale
The placenta does not cushion the fetus from maternal movement. Instead, the amniotic fluid within the amniotic sac provides cushioning and protection to the fetus from external forces and maternal movements.
Choice B rationale
The placenta does not provide thermoregulation. Thermoregulation is primarily managed by the mother’s body. The placenta’s main functions are related to nutrient and gas exchange, hormone production, and waste removal.
Choice C rationale
The placenta is responsible for metabolic and gas exchange. It provides oxygen and nutrients to the fetus while removing waste products from the fetal blood. This exchange occurs through the placental barrier, which separates maternal and fetal blood.
Choice D rationale
The placenta does not provide a sterile environment. The amniotic sac and its fluid help maintain a sterile environment for the fetus. The placenta’s role is more focused on nutrient and gas exchange, hormone production, and waste removal.