A prenatal nurse is providing instructions to a group of pregnant clients regarding measures to prevent toxoplasmosis.
Which statement, if made by one of the clients, indicates a need for further instructions?

The nurse should anticipate a provider prescription for pyridoxine due to the client’s severe dehydration.

Rationale for correct answers

Pyridoxine (vitamin B6) is recommended for nausea and vomiting in pregnancy (NVP), commonly known as hyperemesis gravidarum (HG), especially in patients with persistent symptoms leading to dehydration. Severe dehydration is confirmed by elevated urine specific gravity (normal: 1.002–1.030), low sodium (normal: 135–145 mEq/L), and positive ketones, indicating excessive vomiting and malnutrition.

Rationale for incorrect Response 1 options

• Antibiotics: There is no evidence of infection; urinalysis and WBC count are within normal limits.
• Magnesium sulfate: Used for eclampsia or preterm labor prevention, not for HG.
• Oxytocin: Stimulates uterine contractions and is contraindicated during early pregnancy unless labor induction is required.

Rationale for incorrect Response 2 options

• Urinary tract infection: No leukocytes or nitrites in urine, and WBC count is normal (4,500–11,000/mm³).
• Preeclampsia: No proteinuria or hypertension (≥140/90 mm Hg).
• Preterm labor: No uterine contractions or cervical changes.

Choice A rationale

Unconjugation of bilirubin is the process where bilirubin, initially produced in a water-insoluble form (unconjugated or indirect bilirubin), is not yet processed by the liver. This form cannot be easily excreted by the body.

Choice B rationale

Albumin binding refers to the transport of unconjugated bilirubin in the bloodstream. Because unconjugated bilirubin is fat-soluble and not easily dissolved in water, it binds to albumin, a protein in the blood, which allows it to be transported to the liver.

Choice C rationale

The enterohepatic circuit describes the circulation of bile acids from the liver to the small intestine, where they aid in fat digestion and absorption, and then back to the liver. Bilirubin is a byproduct of heme breakdown and is processed separately in the liver before excretion in bile.

Choice D rationale

Conjugation of bilirubin is the process that occurs in the liver where the enzyme uridine diphosphoglucuronate glucuronosyltransferase (UGT) attaches glucuronic acid molecules to unconjugated bilirubin. This process transforms the fat-soluble unconjugated bilirubin into a water-soluble form called conjugated (or direct) bilirubin, which can then be excreted in bile into the intestines.