A nurse is caring for a client who has neutropenia due to HEV. Which of the following precautions should the nurse take while caring for this client?

A. Determine the client's pain level: Assessing pain is the first action because dressing changes, especially with negative pressure wound therapy, can be painful. Knowing the client’s pain level allows the nurse to administer analgesics if needed before the procedure, promoting comfort and cooperation and preventing procedural distress.

B. Irrigate the wound with 0.9% sodium chloride irrigation: Wound irrigation is an important step in cleansing before applying negative pressure wound therapy, but it should occur after assessing and managing pain. Performing irrigation without addressing pain first can cause unnecessary discomfort and increase the client’s anxiety.

C. Apply skin preparation to wound edges: Skin preparation protects the surrounding tissue from the adhesive used in negative pressure wound therapy. This step is necessary but should follow pain assessment and any analgesic administration to ensure client comfort during application.

D. Don sterile gloves: Sterile gloves are required to maintain asepsis during the dressing change, but donning them should occur after assessing pain and preparing the client. Starting the procedure without first assessing and managing pain can compromise the client’s safety and experience.

A. Apply internal fetal monitor: An internal fetal monitor is used to assess fetal heart rate and contractions in a viable pregnancy. In this case, the client has a molar pregnancy with no viable fetus, so fetal monitoring is not appropriate and provides no clinical benefit.

B. Prepare client for dilation and curettage with suction: Suction dilation and curettage (D&C) is the primary treatment for a molar pregnancy to remove abnormal trophoblastic tissue. Planning for this procedure is essential to prevent complications such as hemorrhage, persistent gestational trophoblastic disease, and infection.

C. Administer 1 hr glucose tolerance test: Glucose screening is not indicated at this time. The client is only 20 weeks gestation and is being managed for a molar pregnancy, not for routine prenatal care or gestational diabetes screening. This test is not a priority.

D. Refer client to perinatal loss support group: A molar pregnancy is considered a pregnancy loss, and the client may experience emotional distress. Referral to a perinatal loss support group provides psychological support and helps the client cope with grief and anxiety associated with this event.

E. Provide the client with instructions on medroxyprogesterone therapy: Medroxyprogesterone therapy is not indicated for managing a molar pregnancy. Contraception may be discussed after treatment, but this is not an immediate priority during acute management of the condition.

F. Administer Rho(D) immune globulin: The client is Rh-negative, and any procedure that may cause fetomaternal hemorrhage, such as D&C, requires administration of Rho(D) immune globulin to prevent isoimmunization in future pregnancies. This is a critical prophylactic intervention in Rh-negative clients.