A nurse in an outpatient clinic is assessing a client who is pregnant for unsafe behaviors during pregnancy. Which of the following findings indicates a need for further evaluation?

Rationale:
A. A client who has decreased urine cortisol levels: Hypercortisolism or dysregulated cortisol is more commonly linked to depressive symptoms, so decreased levels would not indicate a primary need for antidepressant therapy.

B. A client who has decreased interleukin-6 levels: Interleukin-6 is an inflammatory marker, and elevated levels have been associated with depression. Decreased IL-6 does not indicate inflammation-related depression or a need for antidepressants.

C. A client who has decreased C-reactive protein levels: Low C-reactive protein indicates minimal systemic inflammation. Since elevated CRP can correlate with depressive states, decreased CRP does not identify a candidate for antidepressant therapy.

D. A client who has decreased serotonin levels: Reduced serotonin is linked to depressive disorders. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), aim to increase serotonin availability in the brain, making this client an appropriate candidate for therapy.

Rationale for Correct Choices

• Intravenous antibiotic: The client shows classic signs of postpartum endometritis, including fever, uterine tenderness, boggy fundus, and foul-smelling lochia. IV antibiotics are the primary treatment to target the uterine infection and prevent progression or sepsis.

• Increase in daily fluid intake: Adequate hydration supports circulation, helps maintain uterine tone, and assists in reducing the risk of complications such as hypotension or dehydration from infection. Fluids also support antibiotic therapy by promoting renal clearance and overall recovery.

Rationale for Incorrect Choices

• Kleihauer-Betke test: This test identifies fetal-to-maternal hemorrhage, which is not indicated here because the client’s hemoglobin is stable and there is no evidence of significant postpartum hemorrhage.

• Tocolytic medication: Tocolytics are used to suppress preterm labor, which is irrelevant for this postpartum client whose uterus has already delivered the fetus.

• Intrauterine tamponade balloon: This intervention is used for severe postpartum hemorrhage to mechanically control bleeding. The client’s bleeding is moderate and the uterus is firm after massage, so this is not indicated at this time.