A nurse is planning care for a child who has neutropenia due to leukemia. Which of the following interventions should the nurse include in the plan of care?

A. WBC count: The client’s WBC count decreased from 33,000/mm³ to 10,000/mm³, returning to the expected postpartum reference range. This decline indicates resolution of the infectious or inflammatory process, consistent with effective antibiotic therapy for postpartum infection such as endometritis.

B. Heart rate: The heart rate decreased from tachycardic values (104–110/min) to 78/min, which is within normal limits. Resolution of tachycardia suggests improvement in systemic stress, infection, and overall hemodynamic stability.

C. Fundal height: The fundus progressed from being above the umbilicus to 4 cm below the umbilicus, demonstrating appropriate uterine involution. This finding reflects improved uterine tone and reduced risk of postpartum hemorrhage or ongoing uterine infection.

D. Temperature: The client’s temperature normalized from febrile readings (38.2–38.6°C) to 37.1°C. Resolution of fever is a key indicator of infection control and clinical improvement following antimicrobial treatment.

E. Hgb: Hemoglobin decreased from 11.1 g/dL to 10 g/dL, which does not indicate improvement. This trend suggests ongoing physiologic postpartum blood loss or dilution and does not reflect recovery.

F. Lochia: Lochia changed from dark brown with foul odor to a small amount of brownish-red lochia without odor. This improvement indicates resolution of uterine infection and normalization of postpartum uterine discharge.

Rationale for correct choices

• Spontaneous abortion: The client is at 10 weeks gestation with vaginal bleeding, abdominal cramping, and an open cervix, which are classic findings associated with spontaneous abortion. The presence of cervical dilation indicates that pregnancy loss is actively occurring or imminent. These findings distinguish spontaneous abortion from other early pregnancy complications.

• Cervical dilation: Cervical dilation during early pregnancy is a key indicator of pregnancy loss. In spontaneous abortion, the cervix opens as products of conception begin to pass. This finding provides objective evidence that the pregnancy is not being maintained.

Rationale for incorrect choices

• Molar pregnancy: Molar pregnancy is associated with excessively high hCG levels, uterine enlargement greater than gestational age, and symptoms such as severe nausea or hyperemesis. The client’s hCG level is appropriate for gestational age and does not suggest trophoblastic overgrowth. Cervical dilation is not a defining feature of molar pregnancy.

• Ectopic pregnancy: Ectopic pregnancy typically presents with unilateral pelvic pain, possible shoulder pain, and often no cervical dilation. Vaginal bleeding may occur, but the cervix usually remains closed. Additionally, ectopic pregnancies often have lower-than-expected hCG levels.

• Lower abdominal cramping: Abdominal cramping is a common symptom in many early pregnancy complications and is not specific to spontaneous abortion. While it supports uterine activity, it does not independently confirm pregnancy loss. Cervical dilation provides stronger diagnostic evidence. Cramping alone is insufficient as the primary indicator.

• hCG levels: The client’s hCG level is within the expected range for 10 weeks gestation. Abnormally high levels would suggest molar pregnancy, while low or slowly rising levels might suggest ectopic pregnancy or nonviable gestation. In this case, hCG does not explain the acute findings.