A nurse is teaching a client who is at 38 weeks of gestation about a contraction stress test. Which of the following statements should the nurse include in the teaching?

Rationale:

• Prenatal anemia: Anemia reduces immune function and tissue oxygenation, making the client more susceptible to postpartum infections, including uterine and systemic infections.
• High parity: Multiparity increases the risk of uterine atony due to repeated stretching and decreased tone of the uterine muscles. This predisposes the postpartum client to poor uterine contraction and increased risk of hemorrhage.
• Polyhydramnios: Excessive amniotic fluid causes uterine overdistension, which weakens uterine contractility and increases the risk of atony and postpartum hemorrhage.
• Prolonged rupture of membranes: Extended rupture of membranes (>18 hours) significantly increases the risk of intrauterine or postpartum infection, including endometritis, due to ascending bacteria from the vaginal canal. This can lead to fever, leukocytosis, and foul-smelling lochia.

Rationale for correct choices

• an endoscopy: The client reports a 3-week history of gnawing, burning epigastric pain that radiates to the back, worsens after meals, and is accompanied by one episode of dark, tarry stool. These symptoms suggest a possible peptic ulcer or gastrointestinal bleeding. An endoscopy is the definitive diagnostic procedure to visualize the gastric mucosa, identify ulcers, and assess for bleeding.

• stool test results: The presence of a dark, tarry stool indicates possible gastrointestinal bleeding (melena). Stool testing, such as a fecal occult blood test, provides objective evidence of bleeding and guides the urgency and necessity of endoscopy. This finding is a key indicator for further gastrointestinal evaluation.

Rationale for incorrect choices

• oxygen via nonrebreather mask: The client’s respiratory assessment shows bilateral clear breath sounds and no signs of hypoxia. Oxygen therapy is not indicated based on current findings, as there is no respiratory compromise.

• an antifungal prescription: There is no evidence of fungal infection. The client’s symptoms are consistent with gastrointestinal pathology, not a fungal etiology. Prescribing an antifungal would be inappropriate without clinical or laboratory indications.

• respiratory rate: The respiratory rate is normal and does not correlate with the presenting gastrointestinal symptoms. It is not a primary indicator for diagnostic intervention in this case.

• temperature: The client does not report fever or signs of infection at this time. While monitoring temperature is standard, it is not a primary indicator for diagnosing peptic ulcer disease or gastrointestinal bleeding in this scenario.