Nursing Care With Sudden Pregnant Complications

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to:

A. Stimulate fetal surfactant production.

The nurse in a maternity unit is providing emotional support to a client and her significant other who are preparing to be discharged from the hospital after the birth of a dead fetus. Which statement made by the client indicates a component of the normal grieving process?

1. "We want to attend a support group."

A stillborn baby was delivered in the birthing suite a few hours ago. After the delivery, the family remained together, holding and touching the baby. Which statement by the nurse would assist the family in their period of grief?

1. "What can I do for you?"

An ultrasound is performed on a client at term gestation who is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that abruptio placentae is present. On the basis of these findings, the nurse should prepare the client for which anticipated prescription?

1. Delivery of the fetus

The client is admitted with full-thickness burns may be developing DIC. Which signs/symptoms would support the diagnosis of DIC?

1. Oozing blood from the IV catheter site

The maternity nurse is caring for a client with abruptio placentae and is monitoring her for disseminated intravascular coagulation (DIC). Which assessment findings are most likely associated with disseminated intravascular coagulation? Select all that apply.

1.Petechiae 2.Hematuria 4.Prolonged clotting times 5.Oozing from injection sites

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement made by the client indicates a need for further instruction?

2. "I will maintain strict bed rest throughout the remainder of the pregnancy."

Which lab result would the nurse expect in the client diagnosed with DIC?

2. A low fibrinogen level

The nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which risk associated with placenta previa?

2. Hemorrhage

The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data, if noted on the client's record, should alert the nurse that the client is at risk for a spontaneous abortion?

2. History of syphilis

The maternity nurse is preparing for the admission of a client in the third trimester of pregnancy who is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the primary health care provider's prescriptions and should question which prescription?

2. Obtain equipment for a manual pelvic examination.

The nurse is assessing a pregnant client in the second trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which assessment finding should the nurse expect to note if this condition is present?

2. Uterine tenderness

A woman who's 36 week pregnant comes into L&D with mild contractions. Which of the following complications should the nurse watch for when the client informs her that she has placenta previa?

2. Vaginal bleeding

The nurse in a maternity unit is reviewing the clients' records. Which clients should the nurse identify as being at the most risk for developing disseminated intravascular coagulation (DIC)?

3. A gravida II who has just been diagnosed with dead fetus syndrome 5. A primigravida at 29 weeks of gestation who was recently diagnosed with severe preeclampsia Ada la ito ha duha dida

A 35-week-gestation pregnant woman is transferred to the maternity unit from the emergency department, where she was treated for minor injuries sustained in a motor vehicle crash. The maternity nurse's priority will be to assess for which complication?

3. Abruptio placentae

Which collaborative treatment would the nurse anticipate in the client diagnosed with DIC?

3. Administer fresh frozen plasma

The nurse is performing a prenatal assessment on a pregnant client. The nurse should plan to implement teaching related to risk for abruptio placentae if which information is obtained on assessment?

3. The client has a history of hypertension.

The nurse receives an order to start an infusion for a client whos hemorrhaging due to a placenta previa. What supplies will be needed?

3. Y tubing, normal saline, 18G cath Blood transfusions require Y tubing Normal Saline solution to mix with the blood product and an 18G cath to avoid lysing breaking the RBCs.

A client arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. The client tells the nurse that a home pregnancy test was positive but that she began to have mild cramps and is now having moderate vaginal bleeding. On physical examination of the client, it is noted that she has a dilated cervix. Which statement, if made by the client, indicates that the client is interpreting the situation correctly?

4. "I will need to prepare myself and my family for the loss of this pregnancy." The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data, if noted on the client's record, should alert the nurse that the client is at risk for a spontaneous abortion?

The nurse is preparing a plan of care for a client who just delivered a dead fetus. Which initial action should the nurse include in the client's plan of care to meet the emotional needs of the client and spouse?

4. Assess the client's and spouse's perception of the event.

The nurse writes a diagnosis of "potential for fluid volume deficit related to bleeding" for a client diagnosed with DIC. Which would be an appropriate goal?

4. The client's urine output will be > 30 mL per hour

The nurse suspects that a patient who has severe sepsis now has disseminated intravascular coagulation​ (DIC). Which​ finding, if​ observed, helps confirm this​ suspicion?

A. Petechiae

During a prenatal visit, the nurse finds that the client has decreased mobility and symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis?

A. Teach gentle lower extremity exercises to the client.

The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm births.

A. Viral

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug?

B. Assessing for chest discomfort and palpitations

A client with disseminated intravascular coagulation is experiencing joint pain. Which nursing intervention should the nurse use to help the client at this time?

B) Cool compresses

A client with a diagnosis of chronic disseminated intravascular coagulation​ (DIC) is being discharged home. Which statement by the client requires the nurse to follow​ up?

B. "The effects of the disorder will resolve​ completely."

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she would be able to go home. Which response by the nurse is most accurate?

B. "When we can stabilize your preterm labor and arrange home health visits."

The nurse is evaluating the lab results for a client suspected of having disseminated intravascular coagulation​ (DIC). Which laboratory finding supports the​ diagnosis? (Select all that​ apply.)

B. Decreased platelet count C. The presence of schistocytes D. Increased fibrin degradation products

Which therapy will the healthcare provider prescribe for the client with chronic disseminated intravascular coagulation​ (DIC)?

B. Heparin

The nurse is caring for a client diagnosed with placental abruption who now has disseminated intravascular coagulation​ (DIC). Which statement correctly explains why this client is at risk for​ DIC?

B. Leaked fluid is similar to a coagulation factor.

A pregnant client experienced preterm labor at 30 weeks gestation. Upon assessing the client the nurse finds that the newborn is at risk of having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in the newborn?

B. Magnesium sulfate.

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance:

B. Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy.

A nurse caring for a client with disseminated intravascular coagulation (DIC) is reviewing the client's diagnostic tests. Which test result is common in DIC?

C) Decreased fibrinogen level

A client diagnosed with disseminated intravascular coagulation (DIC) is currently bleeding through the gastrointestinal tract. What will the nurse expect to provide for the client?

C) Fresh frozen plasma and platelets

A nurse is assessing a client during labor and delivery. Which condition should the nurse recognize as a risk factor for disseminated intravascular coagulation (DIC)?

C) Placental abruption

A nurse working in labor and delivery is caring for a client with suspected DIC. The nurse is aware that DIC most often occurs in which pregnancy complication?

C) Placental abruption

The nurse is teaching a group of pregnant clients about preterm labor and the actions to take if the signs and symptoms of preterm labor develop. Which patient statement indicates the need for further teaching?

C. "I will lie in the supine position for 1 hour."

If a pregnant client suspects signs and symptoms of preterm labor, which conditions would lead the client to go to hospital immediately? Select all that apply.

C. Fluid leakage from vagina D. Presence of vaginal bleeding E. Contractions every 10 minutes

The primary health care provider prescribes magnesium sulfate (Epsom salts) for a client to prevent preterm labor. Following administration, the nurse observes that the client has a respiratory rate of 10 breaths/minute and deep tendon reflexes. Based on these findings, what interventions would help to prevent complications in the client?

C. Infuse 500 mg of calcium chloride intravenously for 30 minutes.

In planning for home care of a woman with preterm labor, which concern must the nurse address?

C. Prolonged bed rest may cause negative physiologic effects.

The nurse is evaluating care provided to a client with disseminated intravascular coagulation. Which observation indicates care has been successful for this client?

D) No evidence of bleeding

The nurse examines a client at 30 weeks of gestation for cervical dilation. The nurse understands that the infant may be at risk of cerebral palsy if it is born preterm. Which intervention would help to prevent cerebral palsy?

D. Administering magnesium sulfate (Epsom salts) to the client

The nurse concludes that both clotting and bleeding occur during disseminated intravascular coagulation​ (DIC) due to which​ process?

D. Excess release of thrombin uses up clotting factors quicker than they can be replaced.

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects?

D. Serum magnesium level of 10 mg/dL

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring?

D. The cervix is effacing and dilated to 2 cm.

With regard to the care management of preterm labor, nurses should be aware that:

D. The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

Which is the best question the nurse can ask a woman who is leaving the hospital after experiencing a complete spontaneous abortion?

N. "Do you have someone to talk to, or may I give you the names and numbers for some possible grief counselors?" When a woman has a spontaneous abortion one important consideration is the emotional needs of the woman once she is home. She may not want to talk about the loss for a period of time, but the nurse needs to determine her support system for the future. Asking the woman if she is "going to try again" is an inappropriate question for the nurse to ask and diminishes the experience of having a spontaneous abortion. Giving the woman statistical information on spontaneous abortions is not appropriate when this client needs support and caring concern. Offering to give the client resources to aid in smoking cessation is not addressed in the scenario, so this is an inappropriate response.

A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response?

N. "A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." Because of the risk of choriocarcinoma, the woman receives extensive treatment. Therapy includes baseline chest X-ray to detect lung metastasis physical exam including pelvic exam. Serum B-hCG levels weekly until negative results are obtained three consecutive times, then monthly for 6 to 12 months. The woman is cautioned to avoid pregnancy during this time because the increasing B-hCG levels associated with pregnancy would cause confusion as to whether cancer had developed. If after a year B-hCG seruim titers are within normal levels, a normal pregnancy can be achieved.

A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do?

N. "Come to the health facility with any vaginal material passed." This is a typical time in pregnancy for gestational trophoblastic disease to present. Asking the woman to bring any material passed vaginally would be important so it can be assessed for this.

A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's medical record, which of the following would the nurse expect to find?

N. Firm, rigid uterus on palpation

A nurse has been assigned to assess a pregnant client for abruptio placenta. For which classic manifestation of this condition should the nurse assess?

N. "Knife-like" abdominal pain with vaginal bleeding The classic manifestations of abruption placenta are painful dark red vaginal bleeding, "knife-like" abdominal pain, uterine tenderness, contractions, and decreased fetal movement.

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between abruptio placenta and placenta previa. Which statement should the nurse include in the teaching?

N. "Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the cervix; abruptio placenta is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor." Placenta previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus and is the most common cause of painless bright red bleeding in the third trimester.

A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective?

N. "Purse-string sutures are placed in the cervix to prevent it from dilating." The cerclage, or purse string suture is inserted into the cervix to prevent preterm cervical dilatation and pregnancy loss. Staples, glue, or a cervical cap will not prevent the cervix from dilating.

A client experiences a threatened abortion. She is concerned about losing the pregnancy and asks what activity level she should maintain. What is the most appropriate response from the nurse?

N. "Restrict your physical activity to moderate bedrest."

A 16-year-old client gave birth to a 12 weeks' gestation fetus last week. The client has come to the office for follow-up and while waiting in an examination room notices that on the schedule is written her name and "follow-up of spontaneous abortion." The client is upset about what is written on the schedule. How can the nurse best explain this terminology?

N. "Spontaneous abortion is a more specific term used to describe a spontaneous miscarriage, which is a loss of pregnancy before 20 weeks. This term does not imply that you did anything to affect the pregnancy."

A nurse is assessing pregnant clients for the risk of placenta previa. Which of the following clients faces the greatest risk for this condition?

N. A client who had undergone a myomectomy to remove fibroids

A client in her first trimester has just experienced a miscarriage. The nurse knows that which of the following is the most likely cause of the miscarriage?

N. Abnormal fetal development

A pregnant client is admitted to a health care unit with disseminated intravascular coagulation (DIC). Which of the following orders is the nurse most likely to receive regarding the therapy for such a client?

N. Administer cryoprecipitate and platelets

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?

N. Assess the client's vital signs. A suspected ectopic pregnancy can put the client at risk for hypovolemic shock. The assessment of vital signs should be performed first, followed by any procedures to maintain the ABCs.

A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which of the following would be the priority for this woman on admission?

N. Assessing fetal heart tones by use of an external monitor

The nurse is required to assess a pregnant client who is complaining of vaginal bleeding. Which of the following assessments should be considered as a priority by the nurse?

N. Assessing the amount and color of the bleeding

A client is admitted at 22 weeks' gestation with advanced cervical dilatation to 5 centimeters, cervical insufficiency, and a visible amniotic sac at the cervical opening. What is the primary goal for this client at this point?

N. Bed rest to maintain pregnancy as long as possible At 22 weeks' gestation, the fetus is not viable. The woman would be placed on bed rest, total, with every attempt made to halt any further progression of dilatation as long as possible. The nurse would not want this fetus to be born vaginally at this stage of gestation

When providing counseling on early pregnancy loss, the nurse should discuss which factor as the most common cause for spontaneous abortion?

N. Chromosomal abnormality The most common cause for the loss of a fetus in the first trimester is associated with a genetic defect or chromosomal abnormality. There is nothing that can be done, and the mother should feel no fault.

You are caring for a young woman who is in her 10th week of gestation. She comes into the clinic complaining of vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole?

N. Dark red, "clumpy" vaginal discharge

A 28-year-old woman presents in the emergency room with severe abdominal pain. She has not had a normal period for 2 months but she reports that that is not abnormal for her. She has a history of endometriosis. What might the nurse suggest to the physician as a possible cause of the patient's abdominal pain?

N. Ectopic pregnancy

A 28-year-old woman presents in the emergency department with severe abdominal pain. She has not had a normal period for 2 months, but she reports that that is not abnormal for her. She has a history of endometriosis. What might the nurse suggest to the primary care provider as a possible cause of the client's abdominal pain?

N. Ectopic pregnancy Ectopic pregnancy can present with severe unilateral abdominal pain. Given the history of the client and the amount of pain, the possibility of ectopic pregnancy needs to be considered. A healthy pregnancy would not present with severe abdominal pain unless the client were term and she was in labor.

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect?

N. Ensures passage of all the products of conception Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception.

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination there is an elevated hCG level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition?

N. Gestational trophoblastic disease The client is most likely experiencing gestational trophoblastic disease or a molar pregnancy. In gestational trophoblastic disease or molar pregnancy, there is an abnormal proliferation and eventual degeneration of the trophoblastic villi.

A client has been admitted with abruptio placentae. She has lost 1,200 mL of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae?

N. Grade 2 The classifications for abruptio placentae are: grade 1 (mild) - minimal bleeding (less than 500 mL), 10% to 20% separation, tender uterus, no coagulopathy, signs of shock or fetal distress; grade 2 (moderate) - moderate bleeding (1,000 to 1,500 mL), 20% to 50% separation, continuous abdominal pain, mild shock, normal maternal blood pressure, maternal tachycardia; grade 3 (severe) - absent to moderate bleeding (more than 1,500 mL), more than 50% separation, profound shock, dark vaginal bleeding, agonizing abdominal pain, decreased blood pressure, significant tachycardia, and development of disseminated intravascular coagulopathy. There is no grade 4

To which of the following patients being discharged for home must the nurse stress that it is absolutely critical the patient return for monthly follow-up visits? A woman who:

N. Has experienced a molar pregnancy

A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as:

N. Hydatidiform mole.

A woman is admitted with a diagnosis of ectopic pregnancy. For which action would the nurse anticipate beginning preparation?

N. Immediate surgery Ectopic pregnancy means an embryo has implanted outside the uterus, usually in the fallopian tube. Surgery is usually necessary to remove the growing structure before the tube ruptures or repair the tube if rupture has already occurred.

A pregnant woman, approximately 12 weeks' gestation, comes to the emergency department after calling her health care provider's office and reporting moderate vaginal bleeding. Assessment reveals cervical dilation and moderately strong abdominal cramps. She reports that she has passed some tissue with the bleeding. The nurse interprets these findings to suggest which of the following?

N. Inevitable abortion

What would be the physiologic basis for a placenta previa?

N. Low placental implantation

A nurse is reviewing the medical record of a pregnant client diagnosed with placenta previa. The physical exam reveals that the placenta is implanted near the internal os but does not reach it. The nurse interprets this as which type of placenta previa?

N. Low-lying Placenta previa is generally classified according to the degree of coverage or proximity to the internal os, as follows: total placenta previa - the internal cervical os is completely covered by the placenta; partial placenta previa - the internal os is partially covered by the placenta; marginal placenta previa - the placenta is at the margin or edge of the internal os; low-lying placenta previa - the placenta is implanted in the lower uterine segment and is near the internal os but does not reach it.

After an examination, a client has been determined to have an unruptured ectopic pregnancy. Which medication would the nurse anticipate being prescribed?

N. Methotrexate Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy.

The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client?

N. Monitor the client's vital signs and bleeding. A nurse should closely monitor the client's vital signs and bleeding (peritoneal or vaginal) to identify hypovolemic shock that may occur with tubal rupture.

A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm/Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next?

N. Palpate the fundus, and check fetal heart rate. The classic signs of abruptio placentae are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress.

A woman in labor has sharp fundal pain accompanied by slight vaginal bleeding. What is the most likely cause of these symptoms?

N. Premature separation of the placenta Premature separation of the placenta begins with sharp fundal pain, usually followed by vaginal bleeding.

A client in her 38th week of gestation is admitted into the labor and birth unit with painless bleeding from the vagina. The client is diagnosed with placenta previa. When reviewing the client's history, which of the following would the nurse identify as a risk factor for placenta previa?

N. Previous cesarean birth

A client in her 38th week of gestation is admitted into the labor and birth unit with painless bleeding from the vagina. The client is diagnosed with placenta previa. When reviewing the client's history, which factor would the nurse identify as a risk factor for placenta previa?

N. Previous cesarean birth A previous cesarean birth is a risk factor for developing placenta previa. This is due to the damage caused to the endometrial tissue.

When assessing a woman with an ectopic pregnancy, the nurse would suspect that the tube has ruptured based on which finding?

N. Referred shoulder pain Referred pain to the shoulder area indicates bleeding into the abdomen caused by phrenic nerve irritation when a tubal pregnancy ruptures.

A woman in labor is at risk for abruptio placentae. Which assessment would most likely lead the nurse to suspect that this has happened?

N. Sharp fundal pain and discomfort between contractions

Sometimes an ectopic pregnancy occurs outside the woman's uterus. This usually occurs in one of the fallopian tubes. If the embryo continues to grow, it may rupture the tube. What are the signs and symptoms of a ruptured fallopian tube?

N. Shoulder pain

When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding?

N. Slight vaginal bleeding Slight vaginal bleeding early in pregnancy, no cervical dilation, and a closed cervical os are associated with a threatened abortion.

When assessing a pregnant woman with vaginal bleeding, which finding would lead the nurse to suspect an inevitable abortion?

N. Strong abdominal cramping

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion?

N. Strong abdominal cramping Strong abdominal cramping is associated with an inevitable spontaneous abortion.

A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's medical record, the nurse would expect which finding?

N. Sudden dark, vaginal bleeding The uterus is firm to rigid to the touch with abruptio placentae; it is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color.

A young woman presents at the emergency department with complaints of lower abdominal cramping and spotting at 12 weeks' gestation. The physician performs a pelvic examination and finds that the cervix is closed. What does the physician suspect is the cause of the cramps and spotting?

N. Threatened abortion

A woman in week 16 of her pregnancy calls her primary care provider's office to report that she has experienced abdominal cramping, cervical dilation, vaginal spotting, and the passing of tissue. The nurse instructs the client to bring the passed tissue to the hospital with her. What is the correct rationale for this instruction?

N. To determine whether gestational trophoblastic disease is present Gestational trophoblastic disease is abnormal proliferation and then degeneration of the trophoblastic villi. The embryo fails to develop beyond a primitive start. Abnormal trophoblast cells must be identified because they are associated with choriocarcinoma, a rapidly metastasizing malignancy. This is why it is important for any woman who begins to miscarry at home to bring any clots or tissue passed to the hospital with her. The presence of clear fluid-filled cysts changes the diagnosis from a simple miscarriage to gestational trophoblastic disease.

A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy?

N. Use of IUD for contraception Use of an IUD with progesterone has a known increased risk for development of ectopic pregnancies. The nurse needs to complete a full history of the client to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk.

A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse?

N."I can understand your need to find an answer to what caused this. Let's talk about this further." Talking with the client may assist her to explore her feelings. She and her family may search for a cause for a spontaneous early bleeding so they can plan for future pregnancies. Even with modern technology and medical advances, however, a direct cause cannot usually be determined.