A client at 30 weeks gestation is reporting preterm contractions and is noted to be 2 cm dilated.
What teaching will the nurse provide to the client regarding sexual intercourse?

Choice A rationale

Being an elementary school teacher involves exposure to various childhood illnesses, which can be a concern for an immunocompromised SLE patient. However, this environment is generally indoors and does not involve the most significant environmental trigger for SLE flares. While viral infections can trigger the immune system, the risk is often manageable with good hygiene and vaccinations. It is less dangerous than constant, direct environmental exposure to elements that cause direct DNA damage and systemic inflammation.

Choice B rationale

A construction worker is the most concerning occupation because of the high level of ultraviolet (UV) light exposure. UV radiation is a well-known trigger for systemic lupus erythematosus exacerbations. It causes keratinocyte apoptosis, which releases nuclear antigens into the extracellular space. In SLE patients, the immune system fails to clear these antigens, leading to the formation of antinuclear antibodies and systemic inflammation. Constant outdoor work increases the risk of skin lesions and internal organ involvement significantly.

Choice C rationale

An accountant typically works in an office setting with minimal exposure to UV radiation or infectious agents. This is one of the safer occupations for someone with SLE because it allows for a controlled environment and a sedentary pace that accommodates the fatigue often associated with the disease. There are no specific environmental triggers in an accounting office that would typically cause a lupus flare, making it a low-risk career choice for these patients.

Choice D rationale

A registered nurse works in a high-stress environment and is exposed to many pathogens, which can be difficult for someone with a chronic autoimmune condition. However, like the teacher, the nurse usually works indoors and is not exposed to the intense UV radiation that a construction worker faces. While stress and infection are triggers, they are generally considered secondary to the profound impact that direct sunlight has on the pathophysiology of systemic lupus erythematosus.

Choice A rationale

Consuming adequate calories as determined by a dietitian is a primary goal for discharging a client with anorexia nervosa. This indicates that the client is compliant with the nutritional rehabilitation plan and is capable of maintaining a caloric intake sufficient for metabolic needs. Stabilization of eating patterns and the ability to self-regulate intake without purging or restriction are essential benchmarks. It reflects an improvement in the behavioral aspects of the eating disorder and physiological stability.

Choice B rationale

A body mass index (BMI) of 15 is significantly below the healthy range (18.5 to 24.9 kg/m) and indicates that the client remains severely underweight and malnourished. Discharging a client with such a low BMI would be unsafe as they remain at high risk for cardiac arrhythmias, electrolyte imbalances, and organ failure. Clinical guidelines usually require a higher BMI, typically at least 17 or more, along with weight stability, before considering a transition to outpatient care.

Choice C rationale

Dependency on a parent for basic needs indicates a lack of developmental autonomy and poor coping mechanisms, which are often underlying psychological issues in anorexia nervosa. Discharge readiness requires the client to demonstrate age-appropriate independence and the ability to manage self-care. Continued dependency suggests that the psychological triggers and family dynamics contributing to the disorder have not been adequately addressed. The client needs to show functional improvement and emotional resilience before leaving an intensive treatment environment.

Choice D rationale

The statement regarding not being perfect indicates a positive shift in the cognitive distortions and perfectionism frequently associated with anorexia nervosa. Acknowledging that perfection is unattainable suggests that the client is developing healthier thought patterns and reducing the internal pressure that drives restrictive eating. Cognitive behavioral progress is a critical metric for discharge, as it reduces the likelihood of relapse. This shift in mindset shows the client is engaging effectively with psychotherapy and emotional processing.

Choice E rationale

A blood pressure of 108/74 mm Hg is within the normal range (systolic 90 to 120 and diastolic 60 to 80), indicating cardiovascular stability. Clients with active anorexia nervosa often suffer from bradycardia and hypotension due to starvation and reduced metabolic rate. Achieving a stable, normal blood pressure suggests that the client’s autonomic nervous system and fluid volume are recovering. This physiological normalization is a necessary prerequisite for discharge to ensure the client can safely transition to a lower level of care.