The patient at 18 weeks' gestation thinks she might have been exposed to a toxin at work that could affect fetal development. The patient asks the nurse what organs might be affected at this point in pregnancy. The best response of the nurse is:
1. "The brain is developing now and could be affected."
2. "Because you are in the second trimester, there is no danger."
3. "The internal organs like the heart and lungs could be impacted."
4. "It's best to not worry about possible problems with your baby."
Correct Answer: 1
Rationale 1: Maximum brain growth and myelination are occurring at this point in fetal development.
Rationale 2: Although the greatest danger from teratogens is during the embryonic stage (the first 8 weeks of pregnancy), the fetus at 20 weeks is still vulnerable to exposure to teratogens.
Rationale 3: The heart, lungs, and other internal organs form during the embryonic state, or the first 8 weeks of pregnancy. During their formation is when they are most likely to be affected by a teratogen.
Rationale 4: Avoid telling patients to not worry. Doing so indicates to the patient that you don't care about their concerns and will end effective communication.
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