A nurse in a woman's health clinic is obtaining a health history from a client.
Which of the following findings should the nurse identify as increasing the client's risk for developing pelvic inflammatory disease (PID)?

Choice A rationale

A platelet count of 50,000/mm³ is critically low (normal range is 150,000-450,000/mm³) in a client with pre-eclampsia. Thrombocytopenia is a serious complication of pre-eclampsia and can significantly increase the risk of bleeding and hemorrhage. This finding requires immediate reporting and intervention.

Choice B rationale

A hemoglobin level of 11 grams/dL is within the lower end of the normal range for postpartum women (typically 12-15 g/dL) and is not an immediate concern in the context of pre-eclampsia, unless there is a rapid decline or other concerning symptoms.

Choice C rationale

A creatinine level of 0.3 mg/dL is below the normal range for non-pregnant adults (typically 0.6-1.2 mg/dL) and might be lower in pregnancy due to increased glomerular filtration rate. While kidney function should be monitored in pre-eclampsia, this specific value is not immediately alarming.

Choice D rationale

A fasting blood glucose of 65 mg/dL is within the normal range (typically 70-100 mg/dL) and is not a typical finding that requires immediate reporting in pre-eclampsia, although gestational diabetes can sometimes coexist.

Choice A rationale

Monitoring uterine contractions is important during labor, but in the context of late pregnancy bleeding, the immediate priority is to assess the well-being of both the mother and the fetus. Contractions may or may not be present at this stage.

Choice B rationale

Placing clean disposable pads is a reasonable action to manage bleeding and assess its characteristics. However, it does not address the immediate need to evaluate the maternal and fetal status, which is critical in a bleeding episode during late pregnancy.

Choice C rationale

Assessing fetal heart rate (FHR) is crucial to determine fetal well-being in the presence of bleeding. Maternal vital signs (blood pressure, heart rate, respiration) are equally important to evaluate the mother's hemodynamic stability. Bleeding in late pregnancy can compromise both maternal and fetal oxygenation and perfusion, making this assessment the highest priority. Normal maternal heart rate is typically 60-100 beats per minute, and normal maternal blood pressure is typically 90/60 mmHg to 120/80 mmHg. The normal fetal heart rate range is 110-160 beats per minute.

Choice D rationale

Performing a venipuncture for hemoglobin and hematocrit levels will provide information about the extent of blood loss and the mother's oxygen-carrying capacity. While this is an important assessment, it is not the immediate priority compared to evaluating the fetal heart rate and maternal vital signs, which provide real-time information about their current status. Normal hemoglobin for pregnant women typically ranges from 10.5 to 14 g/dL in the first and third trimesters and slightly lower in the second trimester due to hemodilution. Normal hematocrit for pregnant women typically ranges from 32% to 42%.