A nurse in an obstetrics clinic is caring for a client.

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Exhibit 1

Nurses' Notes

Initial visit, 1340:

29-year-old gravida 2, para 0 client presents with report of a positive home pregnancy test from 2 weeks ago. Last menstrual period was 7 weeks ago. Urine human chorionic gonadotropin (hCG) positive. Client reports vomiting several times a day over the last 2 weeks and states, "I'm a vegetarian and I don't usually eat a lot of protein, but it's still hard to keep anything down." Decreased skin turgor noted, oral mucous membranes moist. Weight 79.4 kg (175 lb).

Exhibit 2

Vital Signs

Initial visit, 1330:

• Heart rate 110/min
• Respiratory rate 18/min
• Blood pressure 104/66 mm Hg
• Temperature 36.6° C (97.9° F)
• Oxygen saturation 99% on room air
• Continuation of above exhibit

Exhibit 3

The nurse is reviewing the client's assessment findings and laboratory results.

Laboratory Results

Initial visit, 1600:

• WBC count 7,500/mm3 (5,000 to 10,000/mm3)
• Hgb 10.2 g/dL (11 to 16 g/dL)
• Hct 45% (33% to 47%)
• Platelets 360,000/mm3 (150,000 to 400,000/mm3)
• Sodium 136 mEq/L (136 to 145 mEq/L)
• Potassium 3.3 mEq/L (3.5 to 5 mEq/L)
• BUN 28 mg/dL (10 to 20 mg/dL)

Urinalysis:

• Appearance clear (clear)
• Color dark amber (pale yellow amber)
• pH 7.9 (4.6 to 8)
• Protein 4 mg/dL (0 to 8 mg/dL)
• Specific gravity 1.045 (1.005 to 1.03)
• Leukocyte esterase negative (negative)
• Nitrites none (none)

A. Inform the client about the possible need for reduction of multiple fetuses:

In vitro fertilization (IVF) can lead to the development of multiple embryos, increasing the risk of multiple gestation pregnancies, such as twins or triplets. Multiple gestations pose higher risks for both the mother and the babies, including preterm birth, low birth weight, and other complications. Therefore, the nurse should inform the client about the possibility of needing fetal reduction procedures to reduce the number of fetuses and minimize risks to both the mother and the remaining babies.

B. Instruct the client not to use donor oocytes:

Donor oocytes (eggs) are commonly used in IVF procedures, particularly for clients who have infertility related to egg quality or production issues. The decision to use donor oocytes should be based on individual circumstances and preferences. It is not appropriate for the nurse to instruct the client not to use donor oocytes without knowing the client's specific situation and preferences.

C. Instruct the client to avoid freezing embryos for possible use in the future:

Freezing embryos for future use, known as embryo cryopreservation, is a common practice in IVF. It allows for the preservation of embryos that are not transferred during the initial IVF cycle for potential use in subsequent cycles. Embryo cryopreservation can improve the chances of pregnancy without the need for additional ovarian stimulation and egg retrieval procedures. Therefore, instructing the client to avoid freezing embryos would not be appropriate advice.

D. Inform the client that sperm will be introduced to the uterus during ovulation:

This statement is incorrect. In IVF, fertilization typically occurs outside the body in a laboratory setting. The eggs retrieved from the ovaries are fertilized with sperm in a dish, and the resulting embryos are then transferred to the uterus. Sperm is not introduced to the uterus during ovulation in the context of IVF.

A. Weight loss of 3%:

Newborns commonly experience weight loss in the first few days of life due to factors such as loss of excess fluid and adjustment to feeding. A weight loss of up to 7-10% in the first week is considered normal. Therefore, a weight loss of 3% alone, while notable, is not typically concerning enough to require immediate intervention. However, it should be monitored closely to ensure that the newborn is receiving adequate nutrition and hydration.

B. Voided one time since birth:

Newborns typically pass urine within the first 24 hours after birth. However, the frequency of voiding can vary, and it is not uncommon for a newborn to void only once in the first 24 hours. While it is important for newborns to void regularly to ensure adequate hydration and renal function, voiding once in the first 24 hours may not necessarily indicate a problem, especially if the newborn is breastfeeding. Therefore, while this finding should be monitored, it may not require immediate intervention.

C. Central cyanosis:

Central cyanosis, characterized by bluish discoloration of the lips, tongue, and mucous membranes, indicates inadequate oxygenation of the blood. It suggests a potential respiratory or cardiac problem that requires immediate evaluation and intervention to ensure adequate oxygenation and prevent complications. Central cyanosis is a concerning finding in newborns and warrants prompt attention from healthcare providers to determine the underlying cause and initiate appropriate treatment.

D. Apical pulse rate of 156/min:

The normal range for a newborn's heart rate is typically 120-160 beats per minute. An apical pulse rate of 156/min falls within this range and is not necessarily indicative of a problem, especially if the newborn is active or crying. While variations in heart rate can occur, a rate of 156/min alone may not be alarming. However, it should be monitored for any changes or trends outside the normal range as part of routine newborn assessment.