A nurse is caring for a client in an antepartum clinic following a maternal serum alpha-fetoprotein screening.
The nurse should recognize that an elevated alpha-fetoprotein level is suggestive of which of the following?

Choice A rationale

Nonsteroidal anti-inflammatory drugs (NSAIDs) primarily exert their therapeutic effects through the inhibition of cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis. While they possess analgesic and anti-inflammatory properties that can alleviate pain and swelling associated with thrombophlebitis, NSAIDs do not directly prevent the formation of thrombi or address the underlying coagulopathy. Therefore, their administration is not a primary prophylactic measure against thrombophlebitis development.

Choice B rationale

Early and frequent ambulation promotes venous return by stimulating the calf muscle pump, which compresses deep veins and propels blood back towards the heart. This mechanical action counteracts venous stasis, a major component of Virchow's triad for thrombus formation. By maintaining blood flow velocity and preventing pooling in the lower extremities, ambulation significantly reduces the risk of deep vein thrombosis and subsequent thrombophlebitis.

Choice C rationale

Applying warm, moist packs to the lower legs can provide symptomatic relief by promoting vasodilation and improving local circulation, which may reduce pain and inflammation associated with existing thrombophlebitis. However, this intervention does not prevent the initial formation of a thrombus. In fact, vasodilation could theoretically increase blood flow to an area with an active clot, but it does not address the fundamental mechanisms of thrombogenesis, such as stasis or hypercoagulability.

Choice D rationale

Elastic stockings apply external graduated compression to the lower extremities, with the highest pressure at the ankle and gradually decreasing pressure proximally. This external pressure helps to reduce venous distention, increase venous blood flow velocity, and prevent the pooling of blood in the superficial and deep veins. By mitigating venous stasis, a critical factor in the pathogenesis of thrombophlebitis, elastic stockings effectively reduce the risk of thrombus formation.

Choice A rationale

Discussing a desire for more children is a normal manifestation of a positive postpartum adjustment. This indicates a healthy attachment to the current child and an optimistic outlook on future family expansion, reflecting psychological well-being and a positive coping mechanism in the postpartum period, not a concern.

Choice B rationale

Fatigue and a desire to sleep are common physiological and psychological responses to the physical demands of labor, delivery, and the initial postpartum period, as well as the demands of newborn care. This is a normal physiological recovery process and not indicative of a psychosocial concern.

Choice C rationale

Acknowledging similarities between the newborn and oneself as an infant indicates a healthy process of identification and bonding. This self-referential observation fosters a sense of connection and continuity within the family unit, signifying normal maternal-infant attachment and psychological integration, not a concern.

Choice D rationale

A client's reluctance to feed the newborn can be a significant indicator of potential psychosocial concerns such as postpartum depression, anxiety, or difficulties with maternal-infant bonding. This behavior may suggest a diminished capacity for engaging in essential caregiving activities, warranting further assessment and intervention.