A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?

Choice A reason: Raising the woman's legs is not the best initial response, as it may worsen the dizziness and light-headedness. This is because raising the legs can increase the blood flow to the lower extremities and decrease the blood flow to the brain, which can cause hypotension (low blood pressure) and hypoxia (low oxygen) in the woman and the fetus.

Choice B reason: Having the woman breathe into a paper bag is not the best initial response, as it may not address the underlying cause of the dizziness and light-headedness. This technique is usually used for hyperventilation (rapid breathing), which can cause respiratory alkalosis (high blood pH) and reduce the carbon dioxide levels in the blood. However, the woman may not be hyperventilating, but rather experiencing supine hypotensive syndrome (low blood pressure when lying on the back) due to the pressure of the uterus on the inferior vena cava (a large vein that returns blood to the heart)².

Choice C reason: Turning the woman on her side is the best initial response, as it can relieve the dizziness and light-headedness by improving the blood flow to the brain and the fetus. This is because turning the woman on her side can reduce the pressure of the uterus on the inferior vena cava and increase the cardiac output (the amount of blood pumped by the heart) and the blood pressure. The left lateral position is preferred, as it can also optimize the placental perfusion (the blood flow to the placenta) and the fetal oxygenation.

Choice D reason: Assessing the woman's blood pressure and pulse is an important response, but not the first one. After turning the woman on her side, the nurse should monitor the vital signs and the fetal heart rate to evaluate the condition of the woman and the fetus. The nurse should also check for other signs and symptoms of supine hypotensive syndrome, such as nausea, sweating, and visual disturbances.

Choice A reason: Ceftriaxone is a third-generation cephalosporin that is effective against Neisseria gonorrhoeae, the bacteria that causes gonorrhea. It is administered as a single intramuscular injection and has a high cure rate.

Choice B reason: Penicillin G is not the drug of choice for gonorrhea because of the widespread resistance of N. gonorrhoeae to this antibiotic. Penicillin G may be used in combination with other drugs for some cases of gonorrhea, but it is not the first-line treatment.

Choice C reason: Acyclovir is an antiviral drug that is used to treat herpes simplex virus infections, not bacterial infections like gonorrhea. Acyclovir has no effect on N. gonorrhoeae and is not indicated for gonorrhea treatment.

Choice D reason: Tetracycline is a broad-spectrum antibiotic that can be used to treat some bacterial infections, but it is not the drug of choice for gonorrhea. Tetracycline has a lower efficacy and a higher rate of adverse effects than ceftriaxone for gonorrhea treatment.