Exhibits

A nurse is reviewing the electronic medical record of a client who is at 29 weeks of gestation. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

Rationale:
A. "I will ask your provider to discuss options for discontinuing treatment with you.": This response supports the client’s autonomy and right to refuse treatment while ensuring that the provider is informed to discuss the medical and ethical aspects of stopping therapy. It reflects respect for the client’s wishes and promotes shared decision-making.

B. "You cannot legally discontinue treatment unless you have a living will.": A living will is not required for a client to refuse or discontinue treatment. Competent clients have the legal and ethical right to make decisions about their own care, including the choice to stop therapy, regardless of advance directives.

C. "You must continue with these treatments because they are lifesaving.": This statement disregards the client’s autonomy and imposes the nurse’s opinion on the client’s decision. Even if the treatment is potentially lifesaving, the client has the right to decline it based on their personal values and quality-of-life considerations.

D. "I know your provider thinks these treatments are necessary for you.": This response shifts focus away from the client’s preferences and reinforces the provider’s opinion instead. It fails to acknowledge the client’s emotional and ethical right to choose.

Rationale for Correct Choices

• Intravenous antibiotic: The client shows classic signs of postpartum endometritis, including fever, uterine tenderness, boggy fundus, and foul-smelling lochia. IV antibiotics are the primary treatment to target the uterine infection and prevent progression or sepsis.

• Increase in daily fluid intake: Adequate hydration supports circulation, helps maintain uterine tone, and assists in reducing the risk of complications such as hypotension or dehydration from infection. Fluids also support antibiotic therapy by promoting renal clearance and overall recovery.

Rationale for Incorrect Choices

• Kleihauer-Betke test: This test identifies fetal-to-maternal hemorrhage, which is not indicated here because the client’s hemoglobin is stable and there is no evidence of significant postpartum hemorrhage.

• Tocolytic medication: Tocolytics are used to suppress preterm labor, which is irrelevant for this postpartum client whose uterus has already delivered the fetus.

• Intrauterine tamponade balloon: This intervention is used for severe postpartum hemorrhage to mechanically control bleeding. The client’s bleeding is moderate and the uterus is firm after massage, so this is not indicated at this time.