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. WBC count: A WBC of 13,000/mm³ is within the expected range for pregnancy, as mild leukocytosis commonly occurs due to physiologic changes, and does not require immediate reporting.

B. Fundal height: A fundal height of 27 cm at 29 weeks is slightly below average but may reflect individual variation, fetal position, or maternal factors. This finding warrants monitoring but is not an urgent concern.

C. Fetal heart rate: FHR of 158/min is within the normal range (110–160/min) for a fetus and does not indicate fetal distress, so immediate reporting is not necessary.

D. Hemoglobin: Hemoglobin of 10 g/dL is below the expected range for pregnancy (typically 11–16 g/dL). This indicates anemia, which can affect maternal and fetal oxygenation, making it important to report to the provider for further evaluation and management.

Rationale for Correct Choices

• Endometritis: The client’s postpartum course—cesarean delivery, prolonged rupture of membranes, and postpartum Day 3 fever—places her at high risk for endometritis, a uterine infection. Signs include uterine tenderness, boggy fundus, and foul-smelling lochia.

• Uterus and lochia assessment: The firm but tender uterus with boggy areas and moderate dark brown, foul-smelling lochia are classic indicators of endometritis. These assessment findings directly reflect the infection within the uterine cavity and help guide immediate intervention.

Rationale for Incorrect Choices

• Mastitis: While the client reports firm, warm breasts with nipple discomfort, these symptoms alone without localized redness, unilateral involvement, or systemic malaise are not sufficient to diagnose mastitis. The uterine and lochia findings are more indicative of endometritis.

• Postpartum hemorrhage: Although uterine atony can cause bleeding, the client’s fundus is firm after massage and the lochia is moderate, making hemorrhage less likely at this point. Hemoglobin remains within normal limits, further reducing the likelihood of acute postpartum hemorrhage.

• Fever: Fever is a symptom rather than a diagnosis. While present (38.2° C), it supports the presence of infection but does not specify which type, so it is not the best standalone choice for the evidence used to identify the condition.

• Elevated WBC (markedly 33,000/mm3) confirm a systemic infection, it is a general sign of infection that could apply to any source (e.g., wound or mastitis). The assessment of the uterus and lochia specifically localizes the infection to the reproductive tract.