A female client reports green-yellow vaginal discharge, vaginal itching, and foul-smelling genitals.
She has been sexually active for six months in a monogamous relationship with her boyfriend.
Both were tested for sexually transmitted diseases when she received a hormonal implant five months ago.
The couple broke up a month ago, and since then, she has had unprotected sex with two partners.
The client's symptoms are most consistent with which of the following conditions?

Choice A rationale

Preterm labor is defined as labor that occurs between 20 and 37 weeks of gestation. The patient is already at 37 weeks' gestation, so preterm labor is not a complication to prevent.

Choice B rationale

Gestational diabetes is glucose intolerance that develops during pregnancy. While elevated blood pressure can sometimes be associated with gestational diabetes, magnesium sulfate is not a primary treatment or preventative measure for this condition. Management typically involves dietary changes, exercise, and sometimes insulin.

Choice C rationale

Magnesium sulfate is commonly administered in the setting of preeclampsia with severe features or eclampsia to prevent seizures. The patient's consistently elevated blood pressure readings (above 160/110 mmHg on multiple occasions) indicate severe hypertension, a key diagnostic criterion for preeclampsia with severe features, placing her at high risk for seizures (eclampsia). Magnesium sulfate acts as a central nervous system depressant, reducing neuronal excitability and thus the risk of seizures.

Choice D rationale

Fetal growth restriction (FGR) is a condition where the fetus does not grow at the expected rate in utero. While severe preeclampsia can contribute to FGR due to placental insufficiency, magnesium sulfate is not directly used to prevent fetal growth restriction. The primary focus of magnesium sulfate in this scenario is maternal seizure prophylaxis.

Choice A rationale

Decreased sensation in the lower extremities is an expected effect of epidural anesthesia. Epidurals work by blocking nerve signals in the lower spinal cord, leading to a reduction in feeling and motor function in the legs.

Choice B rationale

Respiratory depression is a serious complication of epidural anesthesia, although rare. The anesthetic can potentially migrate higher in the spinal cord and affect the nerves that control breathing. This requires immediate intervention by the anesthesiologist. Normal respiratory rate for an adult is 12-20 breaths per minute.

Choice C rationale

A blood pressure of 108/62 mm Hg is within the normal range for an adult and is not a cause for immediate concern in a client with an epidural. While hypotension can occur with epidurals, this value is stable. Normal systolic blood pressure is typically 90-120 mm Hg, and normal diastolic blood pressure is 60-80 mm Hg.

Choice D rationale

A sustained fetal heart rate of 150 bpm is within the normal range for a fetus during labor, which is typically 110-160 bpm. This finding does not indicate immediate distress requiring anesthesiologist intervention.

Choice E rationale

Slurred speech is not an expected effect of a properly placed epidural. It could indicate that the local anesthetic has migrated systemically, potentially affecting the central nervous system. This warrants immediate assessment by the anesthesiologist.