When caring for a client with pre-eclampsia, which laboratory result should the nurse report to the physician immediately?

The nurse should anticipate a provider prescription for pyridoxine due to the client’s severe dehydration.

Rationale for correct answers

Pyridoxine (vitamin B6) is recommended for nausea and vomiting in pregnancy (NVP), commonly known as hyperemesis gravidarum (HG), especially in patients with persistent symptoms leading to dehydration. Severe dehydration is confirmed by elevated urine specific gravity (normal: 1.002–1.030), low sodium (normal: 135–145 mEq/L), and positive ketones, indicating excessive vomiting and malnutrition.

Rationale for incorrect Response 1 options

• Antibiotics: There is no evidence of infection; urinalysis and WBC count are within normal limits.
• Magnesium sulfate: Used for eclampsia or preterm labor prevention, not for HG.
• Oxytocin: Stimulates uterine contractions and is contraindicated during early pregnancy unless labor induction is required.

Rationale for incorrect Response 2 options

• Urinary tract infection: No leukocytes or nitrites in urine, and WBC count is normal (4,500–11,000/mm³).
• Preeclampsia: No proteinuria or hypertension (≥140/90 mm Hg).
• Preterm labor: No uterine contractions or cervical changes.

Choice A rationale

Gonorrhea typically presents with a purulent, often thick, yellow discharge. While it can have a foul odor, the description of frothy and bubbly is less characteristic of gonorrhea. Diagnosis usually involves a cervical culture or nucleic acid amplification testing (NAAT).

Choice B rationale

Trichomoniasis, caused by the protozoan *Trichomonas vaginalis*, is characteristically associated with a large amount of yellow-green or gray, frothy, and bubbly vaginal discharge with a distinct, often foul or fishy odor. Microscopic examination of the discharge reveals the motile trichomonads for definitive diagnosis.

Choice C rationale

Chlamydia often presents with a thin or mucopurulent discharge, which may be yellowish, but it is not typically described as frothy or bubbly. Many women with chlamydia are asymptomatic. Diagnosis is usually made through NAAT of cervical or urine samples.

Choice D rationale

Syphilis in its primary stage presents with a painless chancre. Secondary syphilis can involve a generalized rash and flu-like symptoms. Vaginal discharge is not a primary characteristic of either the primary or secondary stages of syphilis. Diagnosis involves serological testing.