A nurse is assessing a woman in the perinatal clinical with ...

[ssal]

A nurse is assessing a woman in the perinatal clinical with diagnosed cervical insufficiency. The woman is in her 18th week of a viable pregnancy. Which action by the nurse is most appropriate?
 
  A.
  Assist with obtaining informed consent for a cerclage.
  B.
  Draw blood to assess the maternal Rh status.
  C.
  Facilitate a transvaginal and abdominal ultrasound.
  D.
  Refer the woman to a perinatal grief specialist.

Question 2

The nurse finds a woman who has recently suffered her third complete abortion crying and saying Why me? What did I do to deserve being punished like this? Which response by the nurse is best?
 
  A.
  Ask the woman if she uses illicit drugs or drinks alcohol during pregnancy.
  B.
  Explain that most miscarriages are related to genetic abnormalities.
  C.
  Offer to call a clergy member or social worker to visit with the woman.
  D.
  Reassure the woman that she is not being punished.

[blakcmamba]

Answer to Question 1

ANS: A
Because the woman has diagnosed cervical insufficiency, a cerclage is appropriate therapy. This purse-string suture closes the cervix so the uterus can contain the pregnancy. It is usually removed in the 37th week to allow for vaginal delivery. Because it is an invasive procedure, informed consent is required. The other options are not necessary in this situation, although if the woman has unresolved grief following prior spontaneous abortions, a referral would be appropriate.

Answer to Question 2

ANS: C
Women (and their partners) frequently need support with any perinatal loss. The best option here would be for the nurse to offer to call a clergy member or social worker to visit and offer assistance. Asking if the woman uses illicit drugs or drinks alcohol sounds as if the nurse is trying to blame the woman for the miscarriages. Simply explaining that most spontaneous abortions involve a fetus with chromosomal abnormalities does nothing to address the woman's feelings, although it should be part of a comprehensive plan of action. Simply reassuring the woman that she is not being punished sounds paternalistic.