Which action is NOT included in Carly Madison's Scenario Action #5?

Which action is NOT included in Carly Madison's Scenario Action #5?

• A. Administer Rh immune globulin intramuscularly.
• B. Instruct the client to avoid inserting anything into the vagina for 2 weeks.
• C. Provide the client with information about pregnancy loss support groups.
• D. Prepare the client for surgery.

Answer: (D)

This item tests recognizing which nursing action does not fit after a pregnancy loss when no surgical procedure is planned. In this scenario, care focuses on medical stabilization, prevention of complications, and emotional support. Administering Rh immune globulin intramuscularly is appropriate for an Rh-negative client after a loss to prevent alloimmunization. Instructing the client to avoid inserting anything into the vagina for two weeks helps minimize infection risk during the recovery period. Providing information about pregnancy loss support groups addresses emotional and psychosocial needs. Preparing the client for surgery, however, would only be indicated if a surgical evacuation or other procedure were anticipated; since that isn’t described here, this action is not included.

This item tests recognizing which nursing action does not fit after a pregnancy loss when no surgical procedure is planned. In this scenario, care focuses on medical stabilization, prevention of complications, and emotional support. Administering Rh immune globulin intramuscularly is appropriate for an Rh-negative client after a loss to prevent alloimmunization. Instructing the client to avoid inserting anything into the vagina for two weeks helps minimize infection risk during the recovery period. Providing information about pregnancy loss support groups addresses emotional and psychosocial needs. Preparing the client for surgery, however, would only be indicated if a surgical evacuation or other procedure were anticipated; since that isn’t described here, this action is not included.