A nurse is caring for a client who has been given methylergonovine intramuscularly for a postpartum hemorrhage. The nurse should monitor for which of the following adverse effects?

Rationale for correct choices:

• Compartment syndrome: The client demonstrates classic neurovascular compromise: severe escalating pain, numbness, inability to move toes, cool extremity, absent distal pulses, delayed capillary refill, and increasing edema. These findings reflect increased intracompartmental pressure compromising circulation and nerve function. This is a limb-threatening postoperative emergency following fractures and splinting.

• Osteomyelitis: The client has an open fracture with internal fixation, drainage at the surgical site, fever, and a marked rise in WBC count. Open fractures significantly increase the risk of bone infection due to direct contamination. Persistent fever and leukocytosis support developing osteomyelitis rather than normal postoperative inflammation.

Rationale for incorrect choices:

• Fat embolism syndrome: Fat embolism typically presents with acute respiratory distress, hypoxemia, altered mental status, and petechial rash. This client maintains adequate oxygen saturation and denies shortness of breath, making this condition less likely at this time.

• Deep vein thrombosis: DVT commonly presents with unilateral calf pain, warmth, erythema, and swelling, but does not cause absent pulses, motor loss, or sensory deficits. The acute neurovascular changes seen here point to arterial compromise rather than venous obstruction.

A. Chloasma: Chloasma refers to hyperpigmented patches on the face, often called the "mask of pregnancy." It is a skin change due to hormonal fluctuations and does not involve the coloration of the vagina or vulva.

B. Ballottement: Ballottement is a technique used during a prenatal exam to detect a floating fetus by tapping the cervix, resulting in a rebound sensation. It is not related to changes in vaginal or vulvar color.

C. Chadwick's sign: Chadwick's sign is the bluish-purple discoloration of the cervix, vagina, and vulva that occurs around 6–8 weeks of gestation due to increased vascular congestion. This is the correct documentation for the observed purplish coloration.

D. Hegar's sign: Hegar's sign is the softening of the lower uterine segment, which can be palpated during early pregnancy. It is a physical finding of the uterus, not a visual change of the vaginal or vulvar tissues.