A nurse is caring for an adolescent who recently found out that they are unexpectedly pregnant. Which of the following statements indicates that the client is emotionally prepared for pregnancy?

A. A client who is postoperative and has a Jackson-Pratt drain. A Jackson-Pratt drain is a routine postoperative device used to prevent fluid accumulation. Unless there are signs of excessive drainage, infection, or blockage, this client does not require immediate attention.
B. A client who is scheduled for surgery in 2 hr. While preoperative preparation is important, it is not the most urgent concern. This client can be attended to after addressing more pressing clinical issues, such as potential hypertensive complications.
C. A client whose blood pressure is 160/90 mm Hg and reports a headache. A significantly elevated blood pressure with a headache may indicate a hypertensive crisis, which increases the risk of stroke or other complications. This client should be assessed immediately to determine the severity and need for intervention.
D. A client who is postoperative and reports intermittent nausea. Nausea is a common postoperative symptom and can often be managed with antiemetics and dietary modifications. It does not pose an immediate life-threatening risk compared to possible hypertensive emergencies.

A. "Your baby will require Apgar scoring every 10 minutes after birth." Apgar scores are assessed at 1 and 5 minutes after birth. Additional assessments are only performed if there are concerns about the newborn’s condition, not at 10-minute intervals.
B. "Your baby's decelerations on the monitor could be caused by your positioning." Late decelerations were noted at 1530, which may indicate uteroplacental insufficiency. Maternal positioning can contribute to decelerations by compressing the umbilical cord or reducing placental perfusion. Repositioning, oxygen administration, and IV fluid boluses may help improve fetal oxygenation.
C. "You should receive betamethasone prior to delivery." Betamethasone is used to enhance fetal lung maturity in preterm labor before 34 weeks of gestation. Since this client is at 37 weeks, betamethasone is not needed.
D. "You will begin pushing when you have dilated more." The client is currently at 9 cm dilation, which is the transition phase of labor. Pushing should not begin until full cervical dilation at 10 cm to prevent cervical trauma and ensure effective labor progression.
E. “I will be monitoring your temperature closely." The client has ruptured membranes, which increases the risk of infection (chorioamnionitis). Frequent temperature monitoring is essential to detect early signs of infection.
F. "During this stage of your labor, you're not allowed to receive pain medication." Pain management options are available at all stages of labor. IV opioids may be avoided close to delivery to prevent neonatal respiratory depression, but epidural anesthesia can still be maintained.
G. "You can have some ice chips, if you would like." Clear fluids and ice chips are generally allowed during labor to help maintain hydration unless there is a contraindication, such as the need for an emergent cesarean under general anesthesia.