A G1P1 patient at 37 weeks' gestation is scheduled for a nonstress test (NST). The nurse's greatest concern is the client's risk of developing related to

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Choice A rationale

During menopause, estrogen levels significantly decline. Estrogen plays a crucial role in maintaining the acidic environment of the vagina, which inhibits the growth of pathogenic bacteria and yeast. A decrease in estrogen leads to a rise in vaginal pH (normal premenopausal pH is 3.8 to 4.5), making the vaginal environment less acidic and more susceptible to infections, including bacterial vaginosis and yeast infections, thus explaining the client's symptoms.

Choice B rationale

While dietary habits and fluid intake can influence overall health, they are not the primary factors directly causing the increased risk of vaginal itching, burning, and infections in a menopausal woman. Hormonal changes are the most significant contributing factor.

Choice C rationale

A history of sexually transmitted infections (STIs) is important to consider, but the onset of these symptoms three years into menopause suggests that hormonal changes related to estrogen deficiency are a more likely primary cause for the recurrent vaginal issues. While past STIs can sometimes have long-term effects, the timing aligns with menopausal changes.

Choice D rationale

The client's genitourinary disorder (specifically, the vaginal changes due to estrogen deficiency) will not alleviate over time without intervention. The decrease in estrogen is a permanent physiological change associated with menopause, and the associated symptoms often persist or worsen without treatment such as hormone therapy or other local treatments to restore vaginal health.

Rationale for Correct Condition

Preeclampsia with severe features is characterized by hypertension (≥160/110 mm Hg), proteinuria, and evidence of end-organ dysfunction. The client’s elevated BP, proteinuria, headache, hyperreflexia with clonus, and abnormal liver function tests indicate severe preeclampsia rather than gestational hypertension or HELLP syndrome. The absence of seizures rules out eclampsia.

Rationale for Correct Actions

Magnesium sulfate prevents seizures by blocking neuronal excitability and reducing cerebral vasospasm, acting as a neuroprotective agent. Labetalol lowers BP by reducing vascular resistance, preventing stroke and organ damage while maintaining uteroplacental perfusion.

Rationale for Correct Parameters

Blood pressure directly reflects disease progression and response to antihypertensives. Severe hypertension increases the risk of cerebral hemorrhage and placental abruption. Deep tendon reflexes indicate neurological involvement. Hyperreflexia signals worsening preeclampsia, while diminished reflexes may indicate magnesium toxicity.

Rationale for Incorrect Conditions

Gestational hypertension lacks proteinuria and systemic involvement. HELLP syndrome involves hemolysis, low platelets, and severe liver dysfunction, which this client does not meet fully. Eclampsia requires the presence of seizures, which are absent.

Rationale for Incorrect Actions

IV antibiotics are not indicated without confirmed infection. Cesarean delivery is considered for fetal distress but is not first-line in controlled preeclampsia. Betamethasone is used for fetal lung maturity before 34 weeks, making it unnecessary at 37 weeks.

Rationale for Incorrect Parameters

Platelet count is relevant for HELLP syndrome but does not guide preeclampsia management alone. Fetal heart rate variability monitors fetal status but does not directly assess preeclampsia severity. Serum bilirubin is not a primary indicator of preeclampsia progression.