A 34-year-old woman complains about pain due to lower abdominal cramping, urine hCG is positive and pelvic ultrasound reveals a 10-week intrauterine pregnancy. The patient states that she is not sure whether to keep the pregnancy. Which of the following is the most appropriate next step in management?

1. A

   Counsel the patient or refer to an appropriate counselor

2. B

   Termination of pregnancy

3. C

   Inform the patient's parents

4. D

   Inform the patient's partner

Appeared in: AIIMS Nagpur NO- 2020

Explanation

• The primary duty of a healthcare provider is to respect the patient's autonomy, which is their right to make their own decisions about their body and healthcare.
• Providing or referring for counseling is a non-directive, supportive action that empowers the patient to explore her feelings and options (continuing pregnancy, adoption, termination) without pressure.
• This approach ensures the patient can make an informed decision that is her own, which is the cornerstone of ethical medical practice in this situation.
• It is the only option that directly addresses the patient's stated uncertainty in a patient-centered and ethically sound manner.

Why Other Options Were Wrong

• Option B: Termination of pregnancy is a potential outcome of the patient's decision-making process, not the next step in management. Proceeding with termination without the patient's clear, informed, and resolved request would be a violation of her autonomy and could be considered assault.
• Option C: The patient is a 34-year-old adult, making her legally competent to make her own healthcare decisions. Informing her parents without her explicit consent is a severe breach of patient confidentiality and privacy rights.
• Option D: Similar to informing her parents, disclosing the patient's health information to her partner without her consent is a violation of confidentiality. The decision to involve a partner rests solely with the patient.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to The core concept tested is the application of ethical principles—specifically patient autonomy, confidentiality, and informed consent—in the management of a patient with an ambivalent or unwanted pregnancy to guide bedside assessment, documentation, and the next nursing action.
• A nurse's role is to be a patient advocate, which includes upholding their right to autonomy and confidentiality. This requires setting aside personal beliefs and providing unbiased, non-judgmental care and information.
• Failure to respect patient confidentiality can have serious legal and professional consequences, including lawsuits and loss of licensure.
• What if the patient was a 16-year-old? The first step would still be confidential counseling to assess her understanding and wishes. However, the provider would also need to be aware of state laws regarding parental consent or notification for minors seeking abortion or prenatal care. The ethical priority remains supporting the minor, but legal constraints may require involving parents or a legal guardian.

How to Approach the Question

• First, identify the patient's status: The patient is a 34-year-old woman, which immediately signals she is a competent adult with the legal right to make her own medical decisions.
• Next, identify the core clinical problem: The patient is 'not sure' or ambivalent. The problem is uncertainty, not a request for a specific action.
• Apply the core ethical principle of patient autonomy. The best action is one that empowers the patient to make her own informed choice.
• Evaluate each option against this principle. Counseling (Option A) supports autonomy. Termination (Option B) presumes a decision has been made. Informing parents (Option C) or a partner (Option D) violates autonomy and confidentiality.
• Select the option that facilitates the patient's decision-making process rather than making a decision for her or violating her rights.

Concept Tested & Keywords

• Concept Tested: The core concept tested is the application of ethical principles—specifically patient autonomy, confidentiality, and informed consent—in the management of a patient with an ambivalent or unwanted pregnancy.
• Stem keywords: 34-year-old woman, 10-week intrauterine pregnancy, not sure whether to keep the pregnancy, most appropriate next step
• Lead-in keywords: most appropriate next step
• Clinical cues: The patient's age (34) establishes her as a legally competent adult.
• Clinical cues: The patient's statement of uncertainty is the central problem to be addressed.

Question ID

Q4FDjaj1JWgx57ArVnjlDu

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1240-1242

E6 Gynecology Williams p. 161-195

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 13070-13072