A 12-year-old recently began bedwetting after parental divorce.
The physical exam is unremarkable. What should the nurse do next?

Choice A rationale

Contractions that increase in intensity are a hallmark of true labor. In true labor, uterine contractions become stronger, more regular, and longer in duration due to increasing myometrial activity and prostaglandin release, which contribute to cervical effacement and dilation. This differs from Braxton Hicks contractions, which typically remain mild.

Choice B rationale

Leakage of fluid from the vagina, often referred to as rupture of membranes, signifies the spontaneous breaking of the amniotic sac. This event can occur before or during true labor and increases the risk of infection and cord prolapse. It is a definitive sign that the labor process has begun or is imminent.

Choice C rationale

Increased bladder pressure is a common discomfort experienced by pregnant clients due to the growing uterus compressing the bladder. However, it is not a specific indicator of true labor. It can occur throughout the third trimester as the fetal head descends into the pelvis, regardless of labor onset.

Choice D rationale

Blood-tinged vaginal mucus, also known as "bloody show," results from the softening and effacement of the cervix, causing capillaries to rupture and release a small amount of blood mixed with mucus. This is a common sign indicating that the cervix is undergoing changes in preparation for labor.

Choice E rationale

Uterine contractions that decrease with rest are characteristic of Braxton Hicks contractions, or "false labor.”. True labor contractions, in contrast, persist and often intensify with activity and do not diminish with rest or changes in position, reflecting progressive physiological changes of labor.

Choice A rationale

Persistent fever, elevated white blood cell count (normal range: 4,000-11,000 cells/µL), and increased pain after 72 hours of antibiotic treatment for osteomyelitis indicate a lack of therapeutic response. This suggests the current antibiotic regimen may be ineffective, or the infection is not responding as expected. Prompt notification of the provider is crucial for re-evaluation of the treatment plan, potential antibiotic adjustment, or further diagnostic investigation to prevent complications like sepsis or chronic osteomyelitis.

Choice B rationale

While pain management is important, requesting only oral analgesics addresses a symptom without addressing the underlying lack of improvement in the infection. Untreated or inadequately treated osteomyelitis can lead to significant morbidity. Prioritizing symptomatic relief over addressing the root cause can delay appropriate medical intervention and worsen the patient's condition.

Choice C rationale

While calcium (normal range: 8.5-10.5 mg/dL) is vital for bone health, encouraging calcium-rich foods is a long-term supportive measure for bone healing. It does not address the immediate and concerning signs of ongoing, uncontrolled infection. Addressing the active infection takes precedence over nutritional support for healing at this stage.

Choice D rationale

While antibiotic therapy does take time to show full effect, 72 hours with worsening symptoms, including elevated WBC, suggests the current therapy is failing. Reassuring the family without addressing these objective signs of non-improvement can delay necessary medical intervention and potentially harm the patient by allowing the infection to progress further.