A nurse is about to administer an injection to a client when the client states, "I don't want that injection. The last time I got that I was sore for a week." The nurse goes ahead and administers the injection against the client's wishes. The nurse committed which of the following?

Rationale for correct choices

• chorioamnionitis: The client’s fever, malodorous vaginal discharge, and tachycardia indicate intra-amniotic infection, making chorioamnionitis the strongest risk. Nitrazine-positive discharge with odor further supports infectious etiology rather than labor-only changes. These findings align with hallmark signs of chorioamnionitis in term pregnancy.

• Temperature: A maternal temperature of 38.7° C demonstrates systemic inflammatory response and is a key diagnostic criterion for intra-amniotic infection. Fever combined with localized vaginal changes increases the likelihood of infection within the amniotic cavity. This makes elevated temperature the most appropriate evidence for the selected risk.

Rationale for incorrect choices

• Abruption placenta: Abruption typically presents with painful bleeding, uterine rigidity, or fetal distress, which are absent here. The client’s symptoms instead center on infection indicators rather than placental separation. No hemodynamic instability or abdominal pain consistent with abruption is reported.

• urinary tract infection: Although leukocyte esterase is positive, the client’s primary symptoms—fever, malodorous discharge, nitrazine-positive fluid—point toward reproductive tract infection rather than urinary involvement. The urinalysis lacks nitrites or other strong evidence of a bacterial UTI. These findings are less consistent than those for chorioamnionitis.

• Contraction patterns: Frequent contractions occur in normal labor progression and do not specifically indicate infection. There is no abnormal uterine activity pattern linked to chorioamnionitis risk. Therefore, contraction pattern does not serve as the defining evidence for this condition.

• Fetal heart rate: A normal baseline FHR of 140/min does not signal infection or distress. Fetal tachycardia would be expected if the fetus were affected by maternal infection, but it is not present here.

A. Case manager: A case manager coordinates care for clients with chronic conditions or complex health needs. For a newborn with an atrial septal defect, the case manager can arrange follow-up appointments, provide education to the family about monitoring for symptoms, and ensure access to cardiology services. This referral supports continuity of care and helps prevent complications.

B. Physical therapist: Physical therapy focuses on improving mobility, strength, and motor function. While important for certain conditions, a newborn with an atrial septal defect typically does not require routine physical therapy unless there are additional developmental or musculoskeletal concerns. It is not the primary referral for cardiac follow-up.

C. Occupational therapist: Occupational therapy helps clients develop fine motor skills and perform daily activities. For a newborn with a heart defect, OT is usually not indicated unless developmental delays or feeding difficulties are present. Cardiac management and follow-up are more urgent concerns at discharge.

D. Nurse manager: The nurse manager oversees nursing staff and unit operations rather than providing direct patient follow-up or discharge planning. Referral to the nurse manager does not address the newborn’s ongoing care needs after discharge and is not part of standard interprofessional follow-up for an atrial septal defect.