Health Promotion and Maintenance
42. A client, who is a primigravida at 10 weeks' gestation, reports mild uterine cramping and slight vaginal spotting without passage of tissue. When assessed, no cervical dilation is noted. Which is the best action by the nurse?
. Anticipate that the woman will be sent home and placed on bedrest.
. Prepare the woman for a dilation and curettage.
. Notify a grief counselor to assist the woman with the imminent loss of her fetus.
. Tell the woman that the doctor will most likely perform a cerclage to help maintain the pregnancy.
Test-Taking Tip
To remember the different types of abortions, the cervix and the passage of tissue are the key. If the cervix is not dilated and no tissue is passed, it is a threatened abortion. If the cervix is dilated and tissue is passed, then imminent abortion is likely to occur.
Content Area: Maternity, Antepartum; Integrated Process: Nursing Process, Implementation; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Potential for Alterations in Body Systems
Health Promotion and Maintenance
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Answer 1 is correct because this client is experiencing a threatened abortion. At this gestation, there is no medical intervention to prevent miscarriage. Bedrest is the expected management. Answer 2 is incorrect because this client is experiencing a threatened abortion; a dilation and curettage would be expected for a client who had passed some tissue, had a dilated cervix, and had an incomplete abortion. Answer 3 is incorrect because this client is experiencing a threatened abortion; notifying a grief counselor to assist the woman with the imminent loss of her fetus is unnecessary. Answer 4 is incorrect because this client is experiencing a threatened abortion; a cerclage is usually done after the first trimester for an incompetent cervix.