• Rh (D) immune globulin. This medication is given to Rh-negative clients to prevent Rh sensitization. Since the client is O+ (Rh-positive), there is no risk of Rh incompatibility, making this medication unnecessary.
• Ibuprofen. This NSAID is prescribed for postpartum pain management. It is not contraindicated for this client, as her medical history and current condition do not interfere with its use.
• Doxycycline. This antibiotic is used to treat mastitis, and there is no reason to clarify its use for this client. Mild tachycardia (HR 102/min) is common postpartum and does not affect doxycycline administration.
• Bisacodyl. This stool softener is used to prevent postpartum constipation. There is no need to clarify its use, as it is safe and appropriate for the client.
• Of the client's blood type. Rh (D) immune globulin is only needed for Rh-negative clients. Since this client is Rh-positive (O+), administration is not required and should be clarified with the provider.
• Of the client's WBC count. The WBC count is 9,500/mm³, which is within the normal range (5,000 to 10,000/mm³). This does not indicate infection or any issue that would require clarification of medication administration.
• Of the client's heart rate. The client’s HR of 102/min is slightly elevated but within expected postpartum changes. This does not affect the safety of prescribed medications, so no clarification is needed.

• Endometritis. The client has fever (38.4°C/101.1°F), tachycardia (HR 108/min), uterine tenderness, and foul-smelling lochia, all of which indicate postpartum uterine infection. Prolonged rupture of membranes and cesarean birth increase the risk of endometritis.
• Engorgement. The client reports firm and heavy breasts but denies nipple discomfort, making engorgement unlikely as the primary issue.
• Deep vein thrombosis. The client has bilateral lower extremity edema but no pain, warmth, or tenderness, which are key signs of DVT.
• Urinary tract infection. The client reports frequent voiding without difficulty, with no dysuria or suprapubic pain, making a UTI unlikely.
• Plan to administer broad-spectrum antibiotic medication. Endometritis is a bacterial infection requiring IV broad-spectrum antibiotics, such as clindamycin and gentamicin, to prevent further complications.
• Administer an oxytocic medication. Oxytocic agents like oxytocin or methylergonovine help contract the uterus, promoting lochia drainage and reducing bacterial growth, which helps resolve infection.
• Apply ice packs to the breasts. This is used to relieve breast engorgement, but the primary concern is infection, not breast discomfort.
• Encourage the client to increase fluid intake. Hydration is important but does not directly treat endometritis, making it a lower priority.
• Initiate anticoagulant therapy. This is necessary for DVT management, but the client does not have symptoms of a clotting disorder.
• Temperature. Fever is a key sign of infection, and monitoring temperature helps assess the effectiveness of antibiotic therapy.
• Lochia amount and odor. Foul-smelling lochia is a major sign of endometritis, and monitoring for changes in amount or color helps evaluate treatment progress.
• Bladder distension. The client is voiding frequently without difficulty, making bladder monitoring unnecessary.
• Integrity of the nipples. This is only relevant for breastfeeding clients, and the client is bottle-feeding, making it not applicable.
• Circumference of lower extremities. This is monitored for DVT progression, which is not suspected in this client.

A. "You will be prescribed diazepam." Diazepam is a benzodiazepine used for anxiety and seizures, but it is not the recommended treatment for opioid use disorder in pregnancy. Prolonged use can lead to neonatal withdrawal symptoms, respiratory depression, and sedation. Additionally, benzodiazepine dependence can develop, complicating the management of opioid withdrawal.
B. "You will be prescribed naloxone." Naloxone is an opioid antagonist used for reversing opioid overdose, but it is not appropriate for long-term treatment of opioid use disorder. When administered to an opioid-dependent pregnant client, naloxone can induce sudden withdrawal, increasing the risk of fetal distress, uterine contractions, and preterm labor. Instead, opioid agonist therapy with methadone or buprenorphine is preferred.
C. "You will be prescribed aripiprazole." Aripiprazole is an atypical antipsychotic used for conditions such as schizophrenia, bipolar disorder, and depression. It has no role in managing opioid dependence, as it does not reduce opioid cravings or withdrawal symptoms. While some clients with opioid use disorder may have coexisting psychiatric conditions requiring antipsychotics, aripiprazole alone does not address opioid addiction.
D. "You will be prescribed methadone." Methadone is the standard treatment for opioid use disorder in pregnancy because it stabilizes opioid levels, preventing withdrawal symptoms and reducing cravings. This approach minimizes the risks of fetal distress, miscarriage, and preterm labor. Methadone maintenance also lowers the likelihood of illicit opioid use, improving prenatal care engagement and neonatal outcomes.

A. "You will not be able to eat or drink anything for 8 hours prior to the test." A nonstress test (NST) is a noninvasive procedure that does not require fasting. Clients are encouraged to eat before the test because fetal movement can be stimulated by food intake. Unlike some other prenatal tests, such as glucose tolerance tests or certain ultrasounds, there are no dietary restrictions before an NST.
B. "You will receive medication through an IV line to stimulate contractions." An NST does not involve medication or contraction stimulation. It is designed to monitor fetal heart rate in response to spontaneous fetal movement. If contractions need to be stimulated for further evaluation, a contraction stress test (CST) or oxytocin challenge test may be performed instead.
C. "You will press the provided button when you feel the baby moving during the test." During an NST, the client is given a button to press whenever they feel fetal movement. The test measures fetal heart rate in response to movement, helping to assess fetal well-being. A reassuring result shows accelerations in fetal heart rate with movement, indicating good oxygenation and neurological function.
D. "You will be required to lie flat on your back for the duration of the test." Lying flat on the back is not recommended, especially in later pregnancy, as it can cause supine hypotensive syndrome by compressing the inferior vena cava. Instead, the client is typically positioned in a semi-Fowler’s position or left lateral position to promote optimal blood flow and comfort during the NST.

A. Round ligament pain. Round ligament pain typically occurs in the second trimester as the uterus expands and stretches the supporting ligaments. It presents as sharp, stabbing pain or a pulling sensation in the lower abdomen or groin, especially with movement. It is not a common discomfort during the first trimester.
B. Perineal discomfort and pressure. Perineal pressure is more common in the third trimester as the fetus grows and descends into the pelvis. Increased fetal weight and engagement in the pelvis contribute to this sensation, but it is not a typical complaint during the first trimester.
C. Tingling in the fingers. Tingling or numbness in the fingers, known as carpal tunnel syndrome, can develop later in pregnancy due to fluid retention and nerve compression. While some clients may experience mild symptoms early on, it is more frequently reported in the second or third trimester.
D. Urination urgency and frequency. Increased urinary urgency and frequency are common in the first trimester due to hormonal changes and increased blood flow to the kidneys. The growing uterus also places pressure on the bladder, further contributing to frequent urination. These symptoms may subside in the second trimester but often return in the third trimester as the fetus descends.

A. Suggest the client apply warm compresses to the affected breast. Warm compresses help relieve pain, improve circulation, and promote milk flow, which can help reduce engorgement and assist in clearing the infection. Frequent breastfeeding or pumping, along with warm compresses, can prevent milk stasis and aid in recovery.
B. Tell the client to apply hydrocortisone ointment to the affected area of the breast. Hydrocortisone ointment is not recommended for mastitis, as it does not treat the infection or relieve symptoms effectively. Mastitis is a bacterial infection that requires antibiotics if severe, and management focuses on continued breastfeeding, warm compresses, and pain relief.
C. Encourage the client to limit oral fluid intake to decrease milk production. Decreasing fluid intake is not recommended, as hydration is essential for milk production and overall recovery. Instead, the client should continue to drink adequate fluids to maintain milk supply and prevent dehydration.
D. Recommend the client avoid wearing a nursing bra until symptoms resolve. A well-fitting, supportive nursing bra can help reduce breast discomfort and prevent further complications. Avoiding a bra may lead to increased breast engorgement and worsening symptoms rather than relief.

A. "Wash your nipples with soap and water daily." Washing the nipples with soap can cause dryness and irritation, leading to cracked skin that increases the risk of infection. Instead, the client should clean the breasts with warm water and pat them dry to maintain nipple integrity and prevent mastitis.
B. "You should use a breast pump if you plan to return to work." Using a breast pump when away from the baby helps prevent milk stasis, which is a major risk factor for mastitis. Regular milk expression ensures continuous drainage, reducing the likelihood of clogged ducts and bacterial infection.
C. "Cover your breasts immediately after feedings." Allowing the nipples to air dry after breastfeeding helps prevent moisture buildup, which can create an environment for bacterial growth. Instead of immediately covering the breasts, the client should let them dry naturally before putting on clothing or nursing pads.
D. "Wear an underwire bra between feedings." An underwire bra can put excessive pressure on breast tissue, leading to blocked milk ducts and increasing the risk of mastitis. A well-fitting, non-restrictive nursing bra is recommended to provide support without compressing milk ducts.

A. Stroke upward on the lateral aspect of the sole of the newborn's foot. The Babinski reflex is elicited by stroking the lateral sole of the foot from the heel to the toes. A normal response in newborns is dorsiflexion of the big toe and fanning of the other toes, indicating an intact central nervous system. This reflex is present at birth and typically disappears by 12 months as the nervous system matures.
B. Place the newborn supine and apply pressure to the soles of the feet. Applying pressure to the soles of the feet does not elicit the Babinski reflex but may trigger the stepping reflex. In this reflex, the newborn responds by making stepping movements, mimicking walking. The stepping reflex is typically present at birth and disappears around 2 months of age as the baby gains neuromuscular control.
C. Pull the newborn up by the wrist from a supine position. This maneuver assesses the traction or pull-to-sit reflex, which evaluates muscle tone and head control. A normal response is initial head lag followed by flexion of the arms and an effort to stabilize the head. This reflex helps assess neuromuscular development but does not test for the Babinski reflex.
D. Touch the corner of the newborn's mouth. Touching the corner of the newborn’s mouth elicits the rooting reflex, which causes the baby to turn the head toward the stimulus with an open mouth. This reflex is important for feeding, as it helps the newborn locate the breast or bottle. It is present at birth and typically disappears around 4 months of age.

A. Collect a dietary history. While nutritional status is important for overall health, it is not a primary factor in selecting a contraceptive method. Certain conditions, such as obesity or vitamin deficiencies, may influence contraceptive choices, but dietary history alone does not determine the best option.
B. Perform unbiased teaching. The nurse should provide comprehensive, nonjudgmental education on all available contraceptive methods, including their effectiveness, benefits, risks, and proper use. This allows the client to make an informed decision based on their personal preferences, medical history, and lifestyle. Unbiased teaching ensures that the client receives accurate information without coercion or judgment.
C. Select the best method of contraception for the client. The decision on contraception should be made by the client, not the nurse. The nurse’s role is to provide information and guidance while respecting the client’s autonomy. Clients have the right to choose a method that aligns with their values, health conditions, and reproductive goals.
D. Assess the client's socioeconomic status. While socioeconomic factors can influence contraceptive access and affordability, they do not determine the best method for the client. The nurse should focus on providing options that fit the client’s needs and ensure they are aware of resources available for contraceptive access if cost is a concern.

A. CBC. A complete blood count (CBC) can help assess for anemia, infection, or hemoconcentration due to dehydration. However, it is not the priority test for hyperemesis gravidarum. The immediate concern is assessing the severity of dehydration and ketosis, which directly impact maternal and fetal health.
B. Serum bilirubin. Serum bilirubin levels are typically measured when liver dysfunction or hemolysis is suspected. Hyperemesis gravidarum is primarily a condition of severe nausea and vomiting, leading to dehydration and ketosis rather than liver impairment. Jaundice and abnormal bilirubin levels would be more indicative of conditions such as HELLP syndrome or cholestasis of pregnancy.
C. Urinalysis of ketones. The presence of ketones in urine indicates prolonged vomiting, dehydration, and inadequate carbohydrate intake, leading to ketosis. Since hyperemesis gravidarum can cause significant nutritional deficits, checking for ketonuria helps determine the severity of the condition and guides the need for IV fluids and nutritional support. This makes it the priority test.
D. Liver enzymes. Liver enzyme tests may be elevated in hyperemesis gravidarum but are not the most immediate concern. While abnormal liver function can occur, it is more commonly associated with conditions such as intrahepatic cholestasis of pregnancy or HELLP syndrome. Evaluating hydration status and ketosis takes precedence in the initial assessment.