A nurse is conducting discharge and teaches parents about the care of their infant after cardiac surgery.

The nurse instructs the parents to notify the physician if the conditions occur. (Select all that apply.)

This is a normal respiratory change in pregnancy caused by elevated levels of estrogen. Estrogen increases blood flow and causes the nasal mucosa to swell, leading to congestion and nosebleeds. This condition is called pregnancy rhinitis and affects up to 20% of pregnant women.

Choice B is wrong because this is not an abnormal cardiovascular change, and the nosebleeds are not an ominous sign. They are usually harmless and do not affect the pregnancy outcome.

Choice C is wrong because there is no evidence that the woman is a victim of domestic violence.

This is a serious accusation that should not be made without proper assessment and screening.

Choice D is wrong because there is no indication that the woman has been using cocaine intranasally. Cocaine use can cause nasal damage and bleeding, but it can also have other signs and symptoms such as agitation, euphoria, dilated pupils, increased heart rate and blood pressure, and risk of miscarriage or preterm labor.

Measles (rubeola) is a communicable disease that is characterized by Koplik’s spots, which are clustered, white lesions on the buccal mucosa opposite the lower molars. They appear two to three days before the measles rash and are pathognomonic for measles.

Choice A is wrong because rubella is a different viral infection that causes a mild rash and fever, but does not have Koplik’s spots.

Choice C is wrong because chickenpox (varicella) is caused by the varicella-zoster virus and produces fluid-filled blisters on the skin, not white spots in the mouth.

Choice D is wrong because exanthema subitum (roseola) is caused by the human herpesvirus 6 or 7 and causes a high fever followed by a pink rash on the trunk and neck, but no oral lesions.