A nurse is caring for a client who is pregnant and is at the end of their first trimester.
The nurse places the Doppler ultrasound in which of the following locations to begin assessing for the fetal heart tones (FHTs)?

Choice A rationale

A sudden drop in grades, increased absenteeism, avoidance of eye contact, and flat affect are significant behavioral and emotional changes that suggest a potential underlying mental health issue. Referring the student to a school social worker, who is trained in mental health assessments and interventions, ensures a timely and appropriate professional evaluation. Early identification and intervention are crucial for improving outcomes in adolescent mental health.

Choice B rationale

Encouraging academic breaks without addressing the root cause of the student's distress is unlikely to resolve the underlying issues. While breaks can be beneficial, they do not provide the comprehensive support needed for significant behavioral and emotional changes that suggest potential mental health concerns. This approach may delay necessary professional intervention.

Choice C rationale

Contacting the child's teacher to discuss tutoring focuses solely on the academic decline and overlooks the emotional and behavioral cues. While academic support might be needed, it does not address the possible mental health component indicated by the flat affect and avoidance of eye contact, which are often symptoms of distress.

Choice D rationale

Notifying the parent to request a medical workup is a reasonable step if a physical health issue is suspected. However, the constellation of symptoms (behavioral changes, emotional blunting, social withdrawal) more strongly points towards a mental health concern rather than a purely physical one, making a referral to a mental health professional more immediately relevant.

Choice A rationale

Increased dietary fiber (cellulose) adds bulk to the stool, promoting peristalsis and facilitating bowel movements. Adequate fluid intake is crucial for softening stool and preventing dehydration, which can exacerbate constipation. Together, these interventions physically aid in the formation and passage of softer, more regular stools, addressing the root cause of pregnancy-related constipation.

Choice B rationale

Regular use of a laxative, especially stimulant laxatives, is generally discouraged during pregnancy due to potential for dependency, electrolyte imbalances, and uterine contractions. While some bulk-forming laxatives might be considered, the primary recommendation focuses on dietary and lifestyle modifications as a safer and more physiological approach to managing constipation.

Choice C rationale

Maintenance of good posture can influence comfort and spinal alignment, but it does not directly address the physiological mechanisms contributing to constipation, such as slowed gastrointestinal motility or insufficient dietary fiber and fluid. While beneficial for overall well-being, it is not a primary intervention for alleviating constipation.

Choice D rationale

Regular use of glycerin suppositories acts as a local irritant and osmotic agent to soften and stimulate the rectum for defecation. While they can provide temporary relief, they do not address the underlying causes of constipation in pregnancy and their regular use can lead to dependency, hindering the body's natural bowel function.