L.W., a 20-year-old college student, comes to the university health clinic for a pregnancy test. She has been sexually active with her boyfriend of 6 months, and her menstrual period is now “a few” weeks late. The pregnancy test result is positive. The patient begins to cry, saying, “I don’t know what to do.” 1. How will you begin to counsel L.W.? 2. What information do you need to obtain from L.W. and why? 3. What options does a woman experiencing a pregnancy have? 4. If your role is to assist her in making a choice, what information will you want L.W. to provide? 5. What are the nurse’s moral and ethical obligations in this situation? 6. L.W. asks you to tell her about abortion. What will you tell her? 7. You tell L.W. there are two types of abortions, vacuum aspiration and medical abortion. How would you explain the difference to her? 8. What are the contraindications to using mifepristone (Mifeprex) for a medical abortion? 9. She tells you that she has heard that if a woman has an abortion, she might not be able to get pregnant again. How would you counsel her? 10. L.W. asks you, “Do you think abortion is killing?” What is your best response? a. “Good question. What do you think about it?” b. “A lot of people think this is what an abortion is.” c. “Absolutely not. What happens with pregnancy is a woman’s choice.” d. “I am not able to answer that question. Are you uncertain about abortion as an option?” 11. What types of emotional reactions do women experience after an abortion? 12. L.W. wants to know about adoption. What will you tell her? 13. You ask L.W. if her boyfriend is aware of the possibility, she was pregnant. She tells you that she did not tell him about her period being late or her visit to the clinic today. She asks you if she should tell him because she is afraid, he will “freak out.” How should you respond? 14. L.W. says she is uncertain as to what to do and wants to know how long she has to decide. How will you respond? 15. L.W. declines an examination and says she needs to “think about all this.” She does make an appointment to return in 1 week. What teaching do you need to provide L.W. about how to care for herself in the meantime? How will you respond?

1. To begin counseling L.W., it is important to approach the situation with empathy and support. Start by expressing understanding for her emotions and let her know that you are there to help her explore her options and make an informed decision.

2. In order to provide appropriate guidance, it is necessary to gather information from L.W. about her medical history, including any pre-existing conditions or potential risks that could affect her choices. Additionally, it is important to inquire about her support system, her relationship with her boyfriend, and her personal values and beliefs surrounding pregnancy and reproductive health.

3. A woman experiencing a pregnancy has several options available to her. These include continuing the pregnancy and parenting the child, adoption, or abortion. Each option carries its own considerations and potential emotional, physical, and social implications.

4. If the role is to assist L.W. in making a choice, it is essential to obtain as much information as possible from her. This information should include her feelings and concerns about each option, her personal circumstances and goals, any financial or practical considerations, and her values and beliefs. This will help facilitate an informed decision-making process.

5. The nurse’s moral and ethical obligations in this situation include advocating for the patient’s autonomy and supporting her in making a decision that aligns with her values and best interests. It is important for the nurse to provide unbiased information, support non-judgmentally, and respect the patient’s confidentiality and right to privacy.

6. When L.W. asks about abortion, it is important to provide her with accurate and evidence-based information. Explain that abortion is a medical procedure that terminates a pregnancy, and it is legal under certain circumstances. Describe the different methods of abortion, including surgical procedures like vacuum aspiration and medication-induced abortions.

7. To explain the difference between vacuum aspiration and medical abortion to L.W., you can explain that vacuum aspiration is a procedure performed by a healthcare provider in a clinic or hospital setting. It involves gentle suction to remove the pregnancy tissue from the uterus. On the other hand, a medical abortion involves taking medication, usually a combination of mifepristone and misoprostol, to induce a miscarriage at home.

8. It is important to discuss the contraindications to using mifepristone (Mifeprex) for a medical abortion with L.W. Contraindications include known or suspected ectopic pregnancy, chronic adrenal failure, and certain medical conditions that require ongoing corticosteroid therapy.

9. When counseling L.W. about concerns regarding future fertility after an abortion, it is important to provide accurate information. Explain that in most cases, abortion does not have any long-term impact on a woman’s ability to get pregnant. However, it is essential to discuss potential risks and complications associated with any medical procedure, and to emphasize the importance of post-abortion follow-up care.

10. When L.W. asks if abortion is killing, the best response would be option a. “Good question. What do you think about it?” This allows her to share her own beliefs and opens up a non-judgmental conversation. It is important to listen to her perspective and provide information that respects her autonomy and decision-making process.

11. Emotional reactions after an abortion can vary greatly among women. Some common emotional reactions include relief, sadness, guilt, and a sense of loss. It is important to provide non-judgmental support and offer resources for counseling or support groups if needed.

12. When discussing adoption with L.W., it is important to provide her with information about the process, including the different types of adoption, legal considerations, and emotional implications. It is crucial to emphasize that adoption is a personal decision and should be based on what feels right for her.

13. In response to L.W.’s question about whether she should tell her boyfriend, it is important to provide non-directive guidance. Explain the benefits of open communication and support, and encourage her to consider how her relationship and the potential impact on both parties might influence her decision. Ultimately, the decision to share the information with her boyfriend should be hers.

14. When L.W. asks about the timeline for decision-making, it is important to inform her about the legal gestational age limits for abortion and any local policies or procedures that may affect the timeline. It is also important to emphasize that the decision should be made based on her own needs and considerations, and that she should take the time she needs to make an informed choice.

15. Before L.W. leaves, it is essential to provide her with information on self-care during this time. This includes guidelines on physical health, emotional well-being, and resources for support. Offer her contact information for follow-up questions or concerns and encourage her to reach out if she needs further assistance.