After ambulating in the hall and returning to bed, the client states that her water broke.
The fetal heart rate is 85 beats per minute, and the vaginal exam reveals the cervix is 90% effaced, 2 cm dilated, vertex presentation, and fetal station -2. There is a pulsating cord felt in the anterior portion of the vagina.
Which intervention would the nurse perform immediately?

Choice A rationale

During menopause, estrogen levels significantly decline. Estrogen plays a crucial role in maintaining the acidic environment of the vagina, which inhibits the growth of pathogenic bacteria and yeast. A decrease in estrogen leads to a rise in vaginal pH (normal premenopausal pH is 3.8 to 4.5), making the vaginal environment less acidic and more susceptible to infections, including bacterial vaginosis and yeast infections, thus explaining the client's symptoms.

Choice B rationale

While dietary habits and fluid intake can influence overall health, they are not the primary factors directly causing the increased risk of vaginal itching, burning, and infections in a menopausal woman. Hormonal changes are the most significant contributing factor.

Choice C rationale

A history of sexually transmitted infections (STIs) is important to consider, but the onset of these symptoms three years into menopause suggests that hormonal changes related to estrogen deficiency are a more likely primary cause for the recurrent vaginal issues. While past STIs can sometimes have long-term effects, the timing aligns with menopausal changes.

Choice D rationale

The client's genitourinary disorder (specifically, the vaginal changes due to estrogen deficiency) will not alleviate over time without intervention. The decrease in estrogen is a permanent physiological change associated with menopause, and the associated symptoms often persist or worsen without treatment such as hormone therapy or other local treatments to restore vaginal health.

Choice A rationale

Rubella immunization is contraindicated during pregnancy due to the theoretical risk to the fetus from the live attenuated vaccine. Administering the vaccine immediately after delivery ensures the mother develops immunity before subsequent pregnancies, protecting future fetuses from congenital rubella syndrome.

Choice B rationale

Administering the rubella vaccine during the first trimester of pregnancy is contraindicated because it is a live attenuated vaccine and poses a potential risk to the developing fetus, potentially causing congenital rubella syndrome which can lead to serious birth defects.

Choice C rationale

Administering the rubella vaccine during the third trimester of pregnancy is also contraindicated due to the potential risk to the fetus. While the risk might be lower later in pregnancy, it is still not recommended to administer live vaccines during gestation.

Choice D rationale

Waiting until the next attempt to get pregnant is not the optimal timing. The recommendation is to administer the rubella vaccine immediately postpartum to ensure the mother is immune before any future pregnancies, thus preventing potential harm to subsequent fetuses. .