What is the next step if bleeding cannot be stopped in spontaneous abortion?

Correct Answer: A

Rationale: If bleeding cannot be stopped in spontaneous abortion, the next step should be surgery for a dilation and curettage (D&C). This procedure involves removing the remaining tissue from the uterus to stop the bleeding and prevent infection. Option B, surgery for a hysterectomy, is not the appropriate next step because a hysterectomy involves the removal of the entire uterus and is a more invasive procedure than a D&C. It is typically reserved for more serious conditions such as cancer or severe uterine bleeding that cannot be controlled by other means. Option C, administration of magnesium sulfate, is not the correct next step because magnesium sulfate is typically used to prevent seizures in pre-eclampsia/eclampsia, not to stop bleeding in spontaneous abortion. It would not address the underlying issue of tissue remaining in the uterus causing the bleeding. Option D, administration of calcium gluconate, is also not the correct next step because calcium gluconate is typically used to treat hypocalcemia or as an antidote for magnesium sulfate toxicity. It would not address the underlying issue of tissue remaining in the uterus causing the bleeding. In summary, the correct next step if bleeding cannot be stopped in spontaneous abortion is surgery for a dilation and curettage to remove the remaining tissue from the uterus and stop the bleeding.

Correct Answer: A

Rationale: Aspiration is a serious complication that occurs when food, liquids, or stomach contents are inhaled into the lungs instead of being swallowed into the esophagus. This can lead to pneumonia, lung abscess, or even respiratory failure. Neurologic dysfunction (choice A) is the correct answer because conditions such as stroke, seizures, or impaired consciousness can lead to difficulty swallowing, increasing the risk of aspiration. Patients with neurologic dysfunction may have impaired gag reflexes or difficulty coordinating their swallowing mechanism, making them more prone to aspiration. Kidney failure (choice B) is incorrect because it does not directly relate to the risk of aspiration. While kidney failure can lead to electrolyte imbalances or fluid overload, which may impact a patient's overall health, it does not specifically increase the risk of aspiration. Gestational diabetes (choice C) is also incorrect as it is a condition related to high blood sugar levels during pregnancy. While gestational diabetes can have complications such as macrosomia (large baby) or birth complications, it does not directly impact the risk of aspiration. Postpartum hemorrhage (choice D) is not directly related to the risk of aspiration. Postpartum hemorrhage is excessive bleeding following childbirth and can lead to complications such as shock or organ failure, but it does not increase the risk of aspiration. In conclusion, monitoring for aspiration is crucial in patients with neurologic dysfunction as they are at a higher risk due to impaired swallowing mechanisms. It is important to assess these patients for signs of aspiration such as coughing while eating or drinking, altered voice quality, or respiratory distress. Regular monitoring and interventions can help prevent aspiration and its potential complications.

Correct Answer: B

Rationale: B: The client is exhibiting expected behavior for labor. This is the correct answer because during labor, it is common for clients to exhibit certain behaviors such as increased pain, restlessness, vocalization, and changes in vital signs. These are all normal responses to the physiological process of childbirth. As a nurse, it is important to recognize and differentiate between normal labor behaviors and signs of distress. A: The client had poor childbirth education. This answer is incorrect because the client's level of education about childbirth does not necessarily dictate their behavior during labor. Even clients who have received extensive childbirth education may still exhibit expected behaviors during labor. It is crucial for nurses to focus on assessing the client's current situation and response to labor rather than making assumptions based on their education level. C: The client is becoming hypoxic. This answer is incorrect because hypoxia (lack of oxygen) is a serious condition that requires immediate intervention. Signs of hypoxia include cyanosis, altered mental status, and difficulty breathing. While it is important for nurses to monitor for signs of hypoxia during labor, there is no indication in the question stem that the client is experiencing hypoxia at this time. D: The client needs alpha-fetoprotein levels checked. This answer is incorrect because alpha-fetoprotein levels are not relevant to assessing the client's situation during labor. Alpha-fetoprotein testing is typically done during pregnancy to screen for neural tube defects and chromosomal abnormalities in the fetus, not to assess the client's condition during labor. Nurses should focus on labor progress and the client's well-being during this time.

Correct Answer: B

Rationale: To assess fetal station, the nurse should palpate the ischial spines. The ischial spines are bony landmarks in the pelvis that indicate the level of the fetal head in relation to the mother's pelvis. Palpating the ischial spines helps determine the descent of the fetal head during labor and assess the progress of labor. The sacral promontory is not the correct structure to palpate to assess fetal station. The sacral promontory is located at the top of the sacrum and is not a reliable indicator of fetal station. Palpating the sacral promontory may provide information about the position of the baby's head in relation to the mother's pelvis but is not as accurate as palpating the ischial spines. The cervix is not the correct structure to palpate to assess fetal station. The cervix is the lower part of the uterus that opens during labor to allow the baby to pass through the birth canal. Palpating the cervix can help determine the dilation and effacement of the cervix but does not provide information about the descent of the fetal head in relation to the mother's pelvis. The symphysis pubis is not the correct structure to palpate to assess fetal station. The symphysis pubis is the bony joint at the front of the pelvis where the two pubic bones meet. Palpating the symphysis pubis does not provide information about the descent of the fetal head in relation to the mother's pelvis. It is important to palpate the ischial spines for an accurate assessment of fetal station during labor.

Correct Answer: C

Rationale: During labor, intense back pain is often associated with the baby being in the occiput posterior position. This means that the baby's head is facing the mother's abdomen, with the back of the head against the mother's spine. Choice A, Mentum anterior, refers to the baby's chin being positioned towards the mother's spine. This position is actually ideal for childbirth as it allows for easier passage through the birth canal and is not typically associated with intense back pain during contractions. Choice B, Sacrum posterior, refers to the baby's back being positioned towards the mother's spine. While this position can cause back pain during labor, it is not typically described as intense and is less common than occiput posterior. Choice D, Scapula anterior, refers to the baby's shoulder blade being positioned towards the mother's spine. This position is not typically associated with intense back pain during contractions, as the baby's head position is more critical in determining the experience of back pain during labor. In summary, the correct answer is C (Occiput posterior) because this position is most likely to cause intense back pain during contractions due to the baby's head pressing against the mother's spine. Choices A, B, and D are incorrect because they do not align with the typical presentation of intense back pain during labor associated with occiput posterior positioning.