A nurse is providing education to a client during a prenatal visit. Which of the following medications should the nurse include as contraindicated during pregnancy?

Rationale:

A. Anemia: End-stage kidney disease reduces erythropoietin production by the kidneys, which impairs red blood cell formation in the bone marrow. This often leads to normocytic, normochromic anemia in affected clients.

B. Oliguria: As kidney function declines, urine output diminishes. Oliguria, defined as urine output less than 400 mL/day, is a common clinical feature of advanced kidney failure due to decreased glomerular filtration.

C. Hypotension: Clients with end-stage kidney disease more commonly experience hypertension due to fluid overload and impaired renin-angiotensin-aldosterone regulation. Hypotension may occur during dialysis but is not a typical baseline finding.

D. Bradypnea: Respiratory compensation for metabolic acidosis in kidney disease typically results in tachypnea, not bradypnea. The body increases respiratory rate to blow off excess CO₂ and correct the acid-base imbalance.

E. Edema: Impaired fluid excretion leads to sodium and water retention, resulting in peripheral, facial, or pulmonary edema. This is a hallmark feature of volume overload in chronic kidney disease.

Rationale for Correct Choices:

• Auditory hallucinations: The client reports hearing voices telling them to act (“I'm being told that it's better to end myself...”), which is a clear example of auditory hallucinations. These are a core positive symptom of schizophrenia and often command in nature.
• Echolalia: The client repeating the nurse’s words indicates echolalia, which reflects disorganized thought and speech. It is another classic positive symptom of schizophrenia and demonstrates impaired cognitive filtering.

Rationale for Incorrect Choices:

• Magical thinking: Magical thinking involves believing one’s thoughts can cause events in the physical world, such as thinking they can control others with their mind. This is not evident in the client’s current statements.
• Thought deletion: Thought deletion is the belief that external forces are removing thoughts from one’s mind. The client does not express this; instead, they report added stimuli (voices), not missing thoughts.
• Boundary impairment: Boundary impairment involves difficulty recognizing personal space or ownership, such as using others’ belongings inappropriately. This behavior has not been described in the current assessment.