The nurse in the obstetrical clinic is setting appointments for clients seeking preconceptual care. Which client should be seen first?

Question

1. 36-year-old, has never been pregnant, takes medication for a seizure disorder
2. 15-year-old, smokes one pack per day, had a miscarriage four months ago
3. 22-year-old, runs long distances, has been on the pill for six years
4. 29-year-old, has had two abortions, takes a multiple-vitamin supplement

Answer 1

1
Rationale:
1. This client is the top priority because she has multiple risk factors: She is over the age of 35 and therefore is at risk for trisomies; some medications are teratogenic, and are contraindicated during pregnancy; and pregnancy is not recommended for women with some conditions. This client needs to see the specialist who prescribes her anti-seizure medication, as well with an obstetric provider to discuss the risks her age present to a possible pregnancy.
2. Although this client has the risks of being young and a smoker, she is not the highest priority.
3. The only risk factor this client has is a need to increase folic acid intake due to being on the pill for six years.
4. This client has no risk factors for pregnancy. A history of more than three abortions increases the risks of preterm labor and infertility, but this client has only had two abortions.