Question

A woman presents to the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for the last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion?

Answer 1

Correct Answers:

Threatened

Rationale :

🩸Bleeding with cramping in early pregnancy alongside a closed cervical os most closely indicates a threatened abortion, because the pregnancy has not yet expelled.

🩺A closed cervix distinguishes threatened abortion from inevitable or incomplete abortions, which typically present with cervical dilation.

📆At ~6 weeks, threatened abortion commonly presents with vaginal bleeding without tissue passage.

🧪In contrast, a missed abortion usually presents with no bleeding and absent fetal cardiac activity, making threatened abortion the best fit here.

📌Core Message

Bleeding and cramping with a closed cervix in early pregnancy most indicates a threatened abortion, not types associated with cervical dilation or tissue passage.

Answer 2

Correct Answers:

Intrauterine growth restriction

Rationale :

🚭Maternal smoking causes uteroplacental vasoconstriction and reduced oxygen delivery, leading to intrauterine growth restriction (IUGR).

📉The most consistent neonatal outcome linked to tobacco exposure is low birth weight/IUGR, rather than structural defects.

🧬Neural tube defects are primarily linked to folate deficiency, not smoking.

❤️Congenital heart defects have multifactorial causes, but smoking is far more strongly associated with growth restriction than with specific cardiac malformations.

📌Core Message

Cigarette exposure reduces uteroplacental perfusion, making IUGR/low birth weight the key neonatal risk—not structural anomalies.

Answer 3

Correct Answers:

Menopause.

Rationale :

🗓️Menopause is defined retrospectively after 12 consecutive months of amenorrhea, so 13 months without menses meets this definition.

🧪It reflects permanent cessation of ovarian function with decreased estrogen and progesterone.

🌡️Climacteric refers to the transition period (perimenopause) with fluctuating cycles, not the completed state of amenorrhea.

🧭Menarche marks the onset of menstruation, and puberty is the broader developmental period—neither fits the scenario.

📌Core Message

Thirteen months of amenorrhea with declining ovarian hormones signifies menopause, not the climacteric transition.

Answer 4

Correct Answers:

Unilateral, cramp-like abdominal pain

Rationale :

📍An ectopic pregnancy most often presents with unilateral pelvic/abdominal pain due to implantation outside the uterus, commonly in a fallopian tube.

🩸Vaginal bleeding in ectopic pregnancy is typically scant; a large amount of red bleeding is less characteristic.

📏Uterine size is usually smaller than expected, not enlarged, at early ectopic gestations.

🤢Severe nausea/vomiting is more typical of hyperemesis gravidarum, not ectopic implantation.

📌Core Message

A suspected ectopic at 8 weeks most often shows unilateral pelvic pain rather than uterine enlargement or profuse bleeding.

Answer 5

Correct Answers:

Trichomoniasis

Rationale :

🧪Trichomoniasis classically causes vulvovaginal inflammation with frothy yellow-green discharge and a malodorous smell, aligning with the greenish description and vaginitis.

👁️BV typically produces thin, gray-white discharge with a strong amine (“fishy”) odor but minimal inflammation, which does not match the noted vulvar/vaginal inflammation.

🧫Candidiasis causes thick, curdy, white discharge with intense pruritus, not greenish and not malodorous.

🧬Chlamydia often has scant or mucopurulent discharge with cervicitis, not a prominent green frothy discharge with vaginitis.

📌Core Message

Marked vaginitis with green, frothy discharge points to trichomoniasis, whereas BV has strong odor but minimal inflammation.

Answer 6

Correct Answers:

Consume foods fortified with folic acid

Rationale :

🧠Adequate folic acid (folate) before conception and in early pregnancy prevents neural tube defects (NTDs) during the first 28 days of embryogenesis.

🥣Fortified grains and supplementation ensure sufficient folate stores at conception, when the neural tube is closing.

🍷Limiting alcohol/tobacco is beneficial but does not specifically target NTD prevention like folic acid does.

🩸Iron supports maternal anemia prevention, not NTD reduction, and aspartame avoidance is unrelated to NTDs.

📌Core Message

Periconceptional folic acid intake from fortified foods/supplements is key to preventing NTDs.

Answer 7

Correct Answers:

Endometriosis

Rationale :

🔥Endometriosis causes cyclic pelvic pain that worsens over time, dyspareunia, and infertility due to ectopic endometrial implants and inflammation.

⏳The progressive nature over 5 years and pain with intercourse strongly fit endometriosis rather than primary dysmenorrhea.

👶Delayed conception for >12 months suggests subfertility, commonly associated with endometriosis.

🌙Primary dysmenorrhea is crampy pain without dyspareunia or infertility, and PMS centers on mood/behavioral symptoms rather than significant pelvic pain.

📌Core Message

Worsening cyclic pelvic pain, dyspareunia, and infertility together most strongly indicate endometriosis.

Answer 8

Correct Answers:

Congenital anomalies in the fetus

Rationale :

🩸Poor glycemic control periconceptionally increases teratogenic risk, leading to higher rates of congenital anomalies (e.g., cardiac, neural tube, caudal regression).

🗓️The first trimester is critical for organogenesis, making preconception counseling vital to optimize A1C/glucose before conception.

📉While fetal growth can be affected later, the early risk is primarily malformations, not low birth weight.

🧪Maternal hypoglycemia episodes can occur but are not the central reason for preconception emphasis on tight control.

📌Core Message

Preconception euglycemia reduces first-trimester teratogenic risk, lowering congenital anomaly rates.

Answer 9

Correct Answers:

Late decelerations

Rationale :

⏱️Late decelerations reflect uteroplacental insufficiency and fetal hypoxia, requiring prompt evaluation and intrauterine resuscitation.

📈Accelerations with movement are reassuring and indicate adequate fetal oxygenation.

📉Early decelerations mirror head compression and are typically benign.

💓A baseline FHR 110–160 (e.g., 126 bpm) is normal and not concerning.

📌Core Message

Late decelerations signal uteroplacental insufficiency and potential fetal hypoxia, unlike accelerations or a normal baseline.

Answer 10

Correct Answers:

Continue the Magnesium sulfate infusion.

Rationale :

🌬️A respiratory rate ≥12/min (here 14/min) and present DTRs indicate no magnesium toxicity, so therapy should continue.

🔌Hyperreflexia (+3 DTRs) suggests ongoing preeclampsia irritability, meaning the seizure-prophylaxis benefit of magnesium is still needed.

🚽Urine output of ~33 mL/hr (100 mL/3 hr) is adequate, reducing concern for magnesium accumulation from renal impairment.

✍️Stopping or giving antidote is indicated when RR <12, absent reflexes, or oliguria, none of which are present.

📌Core Message

With RR ≥12, intact reflexes, and adequate urine output, continue magnesium sulfate for seizure prophylaxis in severe preeclampsia.

3 :
The phase in which the ovarian function and hormone production decline and the patient had a lack of menstrual period for 13 months is known as:

4 :
A nurse is caring for a client who has a suspected ectopic pregnancy at 8 weeks of gestation. Which of the following manifestations should the nurse expect to identify as consistent with the diagnosis?

5 :
A 23-year-old college student has come to see the Nurse Practitioner for treatment of a vaginal infection. Physical assessment reveals inflammation of the vagina and vulva. The vaginal discharge is a greenish and strong fishy odor. With which STI are these findings consistent?

6 :
A nurse is instructing a woman who is contemplating pregnancy about nutritional needs. To reduce the risk of giving birth to a newborn who has neural tube defects (NTD), which of the following information should the nurse include in the teaching?

7 :
A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:

8 :
Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy increase the incidence of

9 :
Which fetal heart rate (FHR) finding would concern the nurse during labor?

3 : The phase in which the ovarian function and hormone production decline and the patient had a lack of menstrual period for 13 months is known as:

4 : A nurse is caring for a client who has a suspected ectopic pregnancy at 8 weeks of gestation. Which of the following manifestations should the nurse expect to identify as consistent with the diagnosis?

5 : A 23-year-old college student has come to see the Nurse Practitioner for treatment of a vaginal infection. Physical assessment reveals inflammation of the vagina and vulva. The vaginal discharge is a greenish and strong fishy odor. With which STI are these findings consistent?

6 : A nurse is instructing a woman who is contemplating pregnancy about nutritional needs. To reduce the risk of giving birth to a newborn who has neural tube defects (NTD), which of the following information should the nurse include in the teaching?

7 : A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:

8 : Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy increase the incidence of

9 : Which fetal heart rate (FHR) finding would concern the nurse during labor?

3 :
The phase in which the ovarian function and hormone production decline and the patient had a lack of menstrual period for 13 months is known as:

4 :
A nurse is caring for a client who has a suspected ectopic pregnancy at 8 weeks of gestation. Which of the following manifestations should the nurse expect to identify as consistent with the diagnosis?

5 :
A 23-year-old college student has come to see the Nurse Practitioner for treatment of a vaginal infection. Physical assessment reveals inflammation of the vagina and vulva. The vaginal discharge is a greenish and strong fishy odor. With which STI are these findings consistent?

6 :
A nurse is instructing a woman who is contemplating pregnancy about nutritional needs. To reduce the risk of giving birth to a newborn who has neural tube defects (NTD), which of the following information should the nurse include in the teaching?

7 :
A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to:

8 :
Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy increase the incidence of

9 :
Which fetal heart rate (FHR) finding would concern the nurse during labor?