A nurse is assessing a client who has systemic lupus erythematous (SLE). Which of the following is an expected finding?

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. 3 months: At 3 months, infants typically have a smaller head circumference, weigh less (around 12–13 lb), have fewer teeth, and have not yet demonstrated standing or significant weight-bearing when held. The developmental milestones observed in this infant exceed those expected at 3 months.

B. 6 months: The infant’s weight (14.5 lb), height (24 inches), presence of two lower central incisors, ability to bear weight when held in a standing position, hold a bottle, and exhibit a social smile align with typical developmental milestones for a 6-month-old. Neurologic reflexes such as Moro and tonic neck reflexes usually disappear by this age.

C. 9 months: By 9 months, infants are usually able to sit without support, may begin crawling, and have more teeth. The inability to sit unsupported indicates the infant is younger than 9 months.

D. 12 months: At 12 months, infants generally are able to stand independently, may begin walking, and have more advanced fine motor skills and additional teeth. The developmental abilities and physical measurements of this infant suggest she is younger than 12 months.