A nurse notes that the fetus of a client in labor is in a vertex presentation at +1 station.
The nurse knows this means the presenting part is at which vaginal exam location?

Choice A rationale

Increased intracranial pressure is not a characteristic lab finding in nephrotic syndrome. This syndrome is a kidney disorder characterized by significant proteinuria, hypoalbuminemia, and hyperlipidemia. Intracranial pressure is a neurological finding and is not directly related to the pathophysiology of nephrotic syndrome.

Choice B rationale

Hypoalbuminemia is a characteristic finding in nephrotic syndrome. The significant loss of protein, specifically albumin, through the damaged glomeruli in the kidneys leads to a low serum albumin level (normal is 3.5 to 5.5 g/dL). This decreased plasma oncotic pressure is responsible for the massive edema seen in these patients.

Choice C rationale

Proteinuria is a defining feature of nephrotic syndrome. The glomerular basement membrane becomes highly permeable to plasma proteins, allowing large amounts of protein, primarily albumin, to leak into the urine. This is a key diagnostic criterion, typically exceeding 3.5 grams per 24 hours.

Choice D rationale

Glucosuria is not a characteristic lab finding of nephrotic syndrome. Glucosuria is the presence of glucose in the urine, which is a hallmark of uncontrolled diabetes mellitus. While kidney function is affected in nephrotic syndrome, it does not typically lead to glucose leaking into the urine.

Choice E rationale

Hyperlipidemia is a characteristic finding in nephrotic syndrome. The liver compensates for the loss of albumin by increasing the synthesis of lipoproteins, leading to elevated cholesterol and triglyceride levels in the blood. This is a secondary effect of the severe hypoalbuminemia.

Choice F rationale

An elevated erythrocyte sedimentation rate (ESR) is a non-specific indicator of inflammation. While it may be elevated in nephrotic syndrome due to the underlying inflammatory process, it is not a specific or characteristic lab finding that defines the syndrome itself, unlike proteinuria or hypoalbuminemia.

A macrosomic infant, weighing over 4000 grams (8 lbs 13 oz), significantly stretches the uterine muscles, leading to a diminished ability to contract effectively after birth. This uterine atony is the primary cause of postpartum hemorrhage. The uterus fails to clamp down on the blood vessels at the placental site, resulting in continuous bleeding. The client’s G6 status further increases this risk due to repeated uterine stretching.

Choice B rationale

Thrombosis is a risk in the postpartum period due to hypercoagulability and venous stasis, but it is not the primary complication associated with a macrosomic infant and high parity. The most immediate and significant risk following this type of delivery is the uterus's inability to contract properly, leading to uncontrolled bleeding. While thrombosis is a concern, it is a secondary risk compared to hemorrhage.

Choice C rationale

Postpartum seizures, also known as eclampsia, are typically associated with preeclampsia and hypertension, not specifically with macrosomic infants or high parity. While a client may have other risk factors for seizures, a large infant and multiparity do not directly cause them. The primary and most immediate physiological risk is the inability of the uterus to involute and stop bleeding.

Choice D rationale

While infection is a risk following any delivery, especially if there are lacerations or a prolonged rupture of membranes, it is not the immediate or most significant complication related to a macrosomic infant. The overwhelming primary concern in this specific scenario is the uterine atony caused by the large infant and multiple pregnancies, which predisposes the client to hemorrhage.