The nurse assesses a preterm infant in the NICU.

What signs should be reported to the physician? (Select the 3 correct answers.)

Choice A rationale

Betamethasone is a potent synthetic glucocorticoid corticosteroid. Its mechanism involves complex metabolic effects, including promoting gluconeogenesis (glucose production) and reducing peripheral glucose uptake and utilization by decreasing insulin sensitivity. This action can lead to hyperglycemia (elevated blood glucose, normal fasting range is 70-100 mg/dL), requiring careful monitoring, especially in pregnant clients with gestational diabetes.

Choice B rationale

Corticosteroids like betamethasone can cause hypokalemia (low potassium, normal range 3.5-5.0 mEq/L) due to their mineralocorticoid-like effect, which promotes sodium reabsorption in exchange for potassium excretion in the renal tubules. Therefore, it is more likely to cause hypokalemia than hyperkalemia (elevated potassium), making this option an incorrect adverse reaction.

Choice C rationale

Betamethasone is not typically associated with hypotension (low blood pressure). If anything, the mineralocorticoid effects of corticosteroids can sometimes lead to fluid retention and an increase in blood pressure due to increased sodium reabsorption, although this is less pronounced than with true mineralocorticoids, and the primary concern is the metabolic effect.

Choice D rationale

Bradycardia (slow heart rate, normal newborn heart rate 110-160 beats per minute) is not a characteristic adverse reaction of systemic corticosteroids like betamethasone. While some drugs affect heart rate, glucocorticoids generally have a minimal direct impact on cardiac chronotropy at therapeutic doses, and their main adverse effects are metabolic and immune-related.

Choice A rationale

While urinary tract infections (UTIs) are a postpartum complication, they typically cause symptoms such as dysuria and fever, and are not a direct physiological cause of increased lochia flow or pooling. The amount of lochia passed is primarily related to the healing of the placental site and the process of uterine involution, not secondary infections of the urinary system.

Choice B rationale

When a client is supine, lochia, which is the normal postpartum vaginal discharge containing blood, decidua, and mucus, can gravitationally pool in the relaxed vagina and uterus. Upon ambulation or position change, the accumulated lochia is suddenly expelled, leading to a gush that can appear excessive and alarming to the client. This is a normal physiological event due to gravity and change in uterine pressure, and is not necessarily indicative of hemorrhage or complication.

Choice C rationale

The lochia typically progresses through three stages: rubra (first 3-4 days), serosa (4-10 days), and alba (up to 6 weeks). The overall amount decreases progressively during the postpartum period as the placental site heals and the uterus involutes. An increase in lochia after the initial days could signal a complication, such as postpartum hemorrhage, making this response scientifically inaccurate regarding the normal progression.

Choice D rationale

Retained placental fragments are a significant cause of secondary postpartum hemorrhage and subinvolution, and are characterized by abnormally heavy or prolonged lochia flow (often bright red). While this is a serious complication, it is not the most probable cause of a sudden gush upon first ambulation, which is more commonly explained by gravitational pooling in the vagina while lying in bed.