The practical nurse (PN) is caring for an infant with ambiguous genitalia and congenital adrenal hyperplasia.
Which intervention should the PN prioritize?

Choice A rationale

Collecting a urine specimen for electrolytes and protein would not directly address the client's acute symptoms of restlessness and apprehension. While important for general assessment, these lab parameters are not the primary indicators of fetal distress or immediate maternal physiological deterioration in this context. Normal electrolyte ranges: sodium 135-145 mEq/L, potassium 3.5-5.0 mEq/L. Protein in urine is usually negative.

Choice B rationale

Moving the client into a dorsal recumbent position can actually exacerbate vena caval compression in a laboring client at 42-weeks gestation, potentially leading to supine hypotensive syndrome, which would worsen rather than alleviate restlessness and apprehension due to decreased cardiac output and uteroplacental perfusion.

Choice C rationale

Encouraging the client to push with the next contraction is inappropriate given her symptoms of restlessness and apprehension. These symptoms could indicate evolving complications, such as hypoxemia or even early stages of hypovolemic shock, requiring immediate assessment of vital signs and fetal well-being before encouraging active labor efforts.

Choice D rationale

Providing information about the baby's status can help alleviate the client's apprehension, especially if her symptoms are related to anxiety about the labor process or fetal well-being, which is common in intrapartum fever. Scientific rationale supports addressing psychological distress to improve coping mechanisms.

Choice A rationale

Daily washing with mild soap and warm water helps remove excess sebum, dead skin cells, and bacteria from the skin surface, which are primary contributors to acne lesion formation. This non-irritating approach prevents further inflammation and maintains skin barrier integrity without triggering compensatory oil production often seen with harsh cleansers.

Choice B rationale

While a dermatologist can provide advanced therapies, the initial approach to acne management often involves lifestyle modifications and over-the-counter treatments. Referring directly to a dermatologist for long-term therapy without first attempting conservative measures may be an overstep for initial PN recommendations, as many mild cases respond to basic hygiene.

Choice C rationale

Scientific evidence does not consistently support a direct causal link between dietary factors like chocolate, carbonated drinks, or fried foods and the exacerbation of acne. Acne development is primarily influenced by hormonal factors, sebum production, bacterial proliferation (Propionibacterium acnes), and follicular hyperkeratinization, not specific food consumption.

Choice D rationale

Manual expression of blackheads can push follicular contents deeper, leading to rupture of the follicle wall, increased inflammation, and potential scarring. Exfoliating scrubs can also irritate inflamed skin, disrupt the skin barrier, and worsen acne, making this an unscientific and potentially harmful recommendation.