A 24-year-old pregnant woman at 26 weeks' gestation is ...

[daltonest1984]

A 24-year-old pregnant woman at 26 weeks' gestation is experiencing her third pregnancy. The patient's obstetric history includes one full-term birth and one preterm birth; both children are alive and well.
 
  Today, the patient arrives at the clinic with complaints of fatigue, insomnia, and continuous backache. She reports that she is a nurse on an oncology unit and is worried about continuing to work her 12-hour shifts. What advice by the nurse would be most appropriate?
  A.
  Can you ask your manager about light-duty work at your job?
  B.
  See if you can take more breaks at work to rest and drink water.
  C.
  With your previous premature birth, you might need to reduce your working hours.
  D.
  You can continue to work as long as you want to and feel able to.

Question 2

A woman in the perinatal clinic is upset that her impending childbirth will cause her to lose her job. What assessment question by the nurse would yield the most important information regarding this situation?
 
  A.
  After you give birth, you will probably want to quit your job anyway.
  B.
  Can you make an appointment with human resources to discuss this?
  C.
  Where do you work and how long have you been there?
  D.
  Why do you think you will be fired after your baby is born?

[karlss]

Answer to Question 1

ANS: C
Although many women do continue to work throughout their pregnancies, certain medical problems and pregnancy complications are a red flag for the woman to reduce her work hours. Examples of these conditions include back problems, preterm labor (both of which this woman has), diabetes, kidney disease, heart disease, hypertension, and a history of spontaneous abortion. Light duty may be an option in addition to decreasing the work hours. Taking more breaks might be advised as well, but with this woman's history and current health complaints she should consider decreasing her working hours. Other factors the nurse should discuss with the patient are the amount of heavy physical labor she does and her exposure to chemotherapeutic agents, both of which are possible environmental hazards to the pregnancy.

Answer to Question 2

ANS: C
The Family Medical Leave Act of 1993 guarantees most women (and men) 12 weeks of unpaid family leave following the birth or adoption of a child. The employee has the right to return to the job without loss of seniority, pay, or benefits. This act applies to federal, state, or local government organizations and any other organization that has 50 or more employees working within 75 miles of the workplace. The employee must have worked at this job at least 12 months or for at least 1,250 hours in the previous year to be eligible. By asking the woman where she works and how long she has been there, the nurse is assessing if the workplace must adhere to this act. Telling the woman she will probably want to quit her job is dismissive of her concerns. Making an appointment with human resources might be a good suggestion, but only after the nurse has assessed the patient's eligibility for the Family Medical Leave Act. Asking why questions is considered a communication barrier, as many people become defensive when questions are worded this way.