A nurse in the labor and delivery unit is completing an admission assessment for a client who is at 39 weeks of gestation. The client reports that she has been leaking fluid from her vagina for 2 days. Which condition is the client most at risk for developing?

Correct Answer: B

Rationale: If a pregnant client is leaking fluid from her vagina, it is important to consider the risk of infection. This is because leaking amniotic fluid can create an opportunity for bacteria to enter the uterus, which can potentially lead to chorioamnionitis, an infection of the fetal membranes. Chorioamnionitis can cause serious complications for both the mother and the baby, including preterm labor, sepsis, and even fetal death. Therefore, the client is most at risk for developing an infection in this scenario. Choice A: Cord prolapse is when the umbilical cord slips through the cervix before the baby, which can lead to compression of the cord and compromise blood flow to the fetus. While this is a serious complication that can occur during labor, it is not directly related to leaking amniotic fluid. Choice C: Postpartum hemorrhage is excessive bleeding after delivery and is not directly related to leaking amniotic fluid during pregnancy. Choice D: Hydramnios, also known as polyhydramnios, is a condition where there is an excessive amount of amniotic fluid surrounding the fetus. This can lead to complications such as preterm labor, fetal malpresentation, and umbilical cord compression, but it is not directly related to leaking amniotic fluid. In conclusion, the correct answer is B (Infection) because the client is most at risk for developing an infection due to leaking amniotic fluid, which can lead to serious complications for both the mother and the baby.

Correct Answer: D

Rationale: Option D is the correct answer because the woman is likely experiencing symptoms of supine hypotensive syndrome, which occurs when the weight of the uterus compresses the vena cava when lying on the back, leading to decreased blood flow to the heart and brain. This can result in dizziness and lightheadedness. Teaching the woman to avoid lying on her back and to rise slowly can help alleviate these symptoms and prevent further complications. Option A, ordering a nonstress test to assess fetal well-being, is incorrect because the woman's symptoms are likely related to her position rather than fetal distress. While monitoring fetal well-being is important during pregnancy, it is not the most appropriate action in this situation. Option B, ordering an EKG, is also incorrect because the woman's symptoms are likely not cardiac-related. Supine hypotensive syndrome is a common issue in pregnancy and can be managed without the need for an EKG. Option C, reporting the abnormal finding immediately to her care provider, is not the most appropriate action in this situation. While it is important to communicate any concerns to the care provider, educating the woman on how to manage her symptoms is a more immediate and practical intervention in this case.

Correct Answer: B

Rationale: B: The nurse stabilizes the base of the uterus with one hand while massaging the fundus. This is the correct action because it ensures that the fundus is properly supported and allows for accurate assessment of the fundal height. Massaging the fundus also helps to prevent postpartum hemorrhage by promoting contractions of the uterus to reduce bleeding. A: The nurse measures the fundal height using a paper tape. This is an incorrect action because measuring the fundal height with a paper tape is not necessary during the immediate postpartum period. The focus should be on assessing the firmness, position, and height of the fundus to ensure proper involution of the uterus. C: The nurse palpates the fundus with the tips of his or her fingers. This action is incorrect because palpating the fundus with the fingertips may not provide enough support to accurately assess the fundal height. It is important to use the palm of the hand to provide adequate support and pressure while assessing the fundus. D: The nurse precedes the assessment with a sterile vaginal exam. This action is incorrect because a sterile vaginal exam is not necessary for assessing the fundus during the immediate postpartum period. The focus should be on assessing the fundus externally to ensure proper involution and prevent complications such as postpartum hemorrhage.

Correct Answer: B

Rationale: Lochia serosa is a type of postpartum vaginal discharge that typically occurs from days 3 to 10 after delivery. This discharge is pinkish-brown in color and contains leukocytes, erythrocytes, serous fluid, and cervical mucus. Choice A (Days 3 and 4 PP) is incorrect because lochia serosa does not start as early as day 3; it typically begins around day 3 and can last up to day 10. Choice C (Days 10-14 PP) is incorrect because lochia serosa usually stops around day 10, so it would not be present up to day 14. Choice D (Days 14 to 42 PP) is incorrect because lochia serosa is not present beyond day 10. After lochia serosa, the discharge transitions to lochia alba, which is a creamy white or light yellow color. Therefore, the correct answer is B (Days 3 to 10 PP) as this is the timeframe during which the client can expect to experience lochia serosa.

Correct Answer: A

Rationale: Option A is the correct answer because the symptoms described by the partner (anger, confusion, having conversations with herself) could indicate a serious mental health issue such as postpartum psychosis. Postpartum psychosis is a rare but severe condition that requires immediate medical attention as it can be life-threatening to both the mother and the baby. By advising the partner to take the client to the nearest emergency room for evaluation, the nurse is ensuring that the client receives the necessary urgent care and support. Option B is incorrect because simply bringing the client to the physician's office for medication may not be sufficient to address the severity of the symptoms described. Postpartum psychosis requires more immediate and intensive intervention than just medication. Option C is incorrect because outpatient care is not appropriate for someone experiencing symptoms of postpartum psychosis. This condition requires immediate and intensive treatment, which is typically not provided in an outpatient setting. Option D is incorrect because while intensive behavioral therapy may be a component of treatment for postpartum psychosis, it is not the most appropriate initial response. In this case, immediate medical evaluation in an emergency room setting is necessary to ensure the safety and well-being of the client and her baby.