A nurse is caring for a client in an antepartum clinic following a maternal serum alpha-fetoprotein screening.
The nurse should recognize that an elevated alpha-fetoprotein level is suggestive of which of the following?

Choice A rationale

Applying witch hazel compresses (often in the form of Tucks pads) is an effective and common intervention for episiotomy discomfort. Witch hazel possesses astringent and anti-inflammatory properties that can reduce swelling, soothe irritation, and promote healing of the perineal tissues, providing significant pain relief for the postpartum client.

Choice B rationale

Administering aspirin is generally contraindicated in the immediate postpartum period, especially if there is any risk of bleeding or if the client is breastfeeding. Aspirin can inhibit platelet aggregation, increasing the risk of postpartum hemorrhage. Safer analgesics, such as NSAIDs like ibuprofen, or acetaminophen, are preferred for pain relief.

Choice C rationale

Having the client use a warm pack is generally not recommended for immediate episiotomy discomfort. While warmth can be soothing, a warm pack can increase blood flow to the area, potentially increasing swelling and discomfort or exacerbating any bleeding in the immediate postpartum period. Cold applications are typically preferred initially.

Choice D rationale

Instructing the client to sit on a soft pillow may provide some comfort by distributing pressure, but it does not directly address the underlying pain and inflammation from the episiotomy. While it can be a supportive measure, it is not as therapeutically effective as direct interventions like cold packs, witch hazel, or appropriate analgesia. .

Choice A rationale

Combined estrogen-progestin contraceptive pills typically regulate the menstrual cycle and can often lead to shorter, lighter periods, or even amenorrhea in some individuals, due to the suppression of endometrial proliferation. The synthetic hormones, estrogen and progestin, stabilize the endometrium, preventing excessive build-up and subsequent heavy bleeding.

Choice B rationale

Medroxyprogesterone acetate (Depo-Provera) is an injectable contraceptive that provides long-acting contraception. It is administered intramuscularly or subcutaneously, but the typical administration frequency is once every 3 months (13 weeks), not once per month. This extended duration of action is due to the sustained release of the progestin.

Choice C rationale

Diaphragms are reusable barrier contraceptive devices. While a single diaphragm can be used for several years, it typically needs to be replaced every 1 to 2 years, or sooner if there is a significant weight change (gain or loss of 10-15 pounds), or after pregnancy, to ensure proper fit and contraceptive efficacy.

Choice D rationale

Oral contraceptives, particularly those containing estrogen and progestin, have been shown to significantly reduce the risk of endometrial cancer. This protective effect is primarily attributed to the progestin component, which counteracts the proliferative effects of estrogen on the endometrium, thereby preventing hyperplasia and subsequent malignant transformation.