A nurse is caring for a client who requests a copy of their medical records immediately. Which of the following responses should the nurse make?

Choice A Reason:
A client who is at 32 weeks of gestation and has premature rupture of membranes is incorrect. This client is at risk for preterm labor and complications related to premature birth. Management involves monitoring for signs of labor, assessing fetal well-being, and potentially administering medications to prevent preterm labor. This requires obstetrical-specific knowledge and expertise.
Choice B Reason:
A multigravida client who has preeclampsia and is receiving misoprostol for induction of labor is incorrect. Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to organs, often the kidneys. Induction of labor in the setting of preeclampsia requires careful monitoring of maternal and fetal well-being, including blood pressure monitoring and fetal heart rate monitoring. Additionally, the use of misoprostol for induction requires understanding of its dosage, administration, and potential side effects, which are specific to obstetrical care.
Choice C Reason:
A primigravida client who is 1 day postoperative following a Cesarean section and has a PCA pump is correct. This client is postoperative following a Cesarean section and is likely in need of pain management through a PCA pump. Postoperative care after a Cesarean section involves monitoring for signs of complications such as infection, bleeding, and wound healing, as well as managing pain effectively. While nurses with medical-surgical experience may be familiar with PCA pumps, the postoperative care of a cesarean section client involves obstetrical-specific considerations such as uterine monitoring, assessment of lochia (vaginal discharge after childbirth), and breastfeeding support.
Choice D Reason:
A client who has gestational diabetes and is receiving biweekly nonstress tests is incorrect. Gestational diabetes requires monitoring of maternal blood glucose levels and fetal well-being. Nonstress tests are a common method of assessing fetal well-being in pregnancies complicated by conditions such as gestational diabetes. Nurses caring for clients with gestational diabetes need to understand the management of blood glucose levels, dietary considerations, insulin administration if needed, and fetal monitoring techniques. This requires obstetrical-specific knowledge and expertise.

Choice A Reason:
Reinforcing the potential consequences of not having advance directives on record is important, but the immediate priority is to ensure that the missing documentation is obtained.
Choice B Reason:
Reminding nurses to obtain advance directive information during the admission process is a proactive approach to preventing future instances of missing documentation. However, the priority now is to address the current gap in documentation for clients already admitted.
Choice C Reason:
Meeting with nursing staff to review the policy regarding advance directives can provide clarification and reinforcement of expectations, but again, the immediate priority is to address the missing documentation for current clients.
Choice D Reason:
Asking nurses who are caring for clients without this information in the medical record to obtain it. The priority action for the nurse manager is to ensure that advance directives, which are critical documents outlining a patient's wishes regarding medical treatment, are obtained for clients who currently lack documentation. This ensures that patients' preferences and choices regarding their care are respected, especially in critical situations.