A nurse is assessing a client who is 12 hours postpartum and received spinal anesthesia for a cesarean birth.
Which of the following findings requires immediate intervention by the nurse?

Choice A rationale: Weight loss

Weight loss during pregnancy, especially in the second trimester, is unexpected unless there is a medical condition such as hyperemesis gravidarum or other nutritional deficiencies. While mild weight fluctuations can occur, a consistent loss of weight rather than gradual gain suggests inadequate caloric intake due to persistent vomiting and dehydration.

Choice B rationale: Breast tenderness

Breast tenderness is a common and expected physiological change during pregnancy due to hormonal fluctuations, particularly increased estrogen and progesterone levels. It is not considered abnormal or unexpected at this stage of pregnancy.

Choice C rationale: Heart rate

A heart rate of 116/min is unexpected, as it is above the normal range for adults (typically 60–100/min). Pregnancy can cause a mild increase in heart rate, but tachycardia above 110/min may indicate dehydration, anemia, or electrolyte imbalance, all of which can stem from excessive vomiting and fluid loss.

Choice D rationale: Vomiting

While occasional nausea and vomiting (morning sickness) can be expected in early pregnancy, persistent vomiting up to eight times daily and symptoms of dehydration (dry mucosa, poor skin turgor, positive ketones in urine) raise concern for hyperemesis gravidarum, a more severe form of pregnancy-related nausea and vomiting.

Choice E rationale: Nasal congestion

Nasal congestion is common during pregnancy due to increased blood volume and vascular changes affecting the nasal mucosa. It is not unexpected and does not indicate a complication.

Choice F rationale: Respiratory rate

A respiratory rate of 20/min falls within the normal range for adults (typically 12–20/min), making it an expected finding.

Choice A rationale

Gonorrhea typically presents with a purulent, often thick, yellow discharge. While it can have a foul odor, the description of frothy and bubbly is less characteristic of gonorrhea. Diagnosis usually involves a cervical culture or nucleic acid amplification testing (NAAT).

Choice B rationale

Trichomoniasis, caused by the protozoan *Trichomonas vaginalis*, is characteristically associated with a large amount of yellow-green or gray, frothy, and bubbly vaginal discharge with a distinct, often foul or fishy odor. Microscopic examination of the discharge reveals the motile trichomonads for definitive diagnosis.

Choice C rationale

Chlamydia often presents with a thin or mucopurulent discharge, which may be yellowish, but it is not typically described as frothy or bubbly. Many women with chlamydia are asymptomatic. Diagnosis is usually made through NAAT of cervical or urine samples.

Choice D rationale

Syphilis in its primary stage presents with a painless chancre. Secondary syphilis can involve a generalized rash and flu-like symptoms. Vaginal discharge is not a primary characteristic of either the primary or secondary stages of syphilis. Diagnosis involves serological testing.