Exhibits

Here are the questions from the mix up well completed.

The nurse is assisting with planning care for the client. After review of the client's electronic medical record (EMR), which of the following interventions should the nurse recommend as anticipated, nonessential, or contraindicated?

Choice A rationale

The vagina is approximately 9-10 cm long, angled posterosuperiorly, therefore inserting the suppository along the posterior vaginal wall allows it to follow the natural curve and reach the maximum depth, promoting optimal absorption and therapeutic effect against the localized candidal infection. This positioning ensures the medication remains in contact with the vaginal mucosa for the duration required. The normal vaginal pH is slightly acidic, ranging from 3.8 to 4.5.

Choice B rationale

The supine position with knees flexed, or the Sims' position (lateral with upper leg flexed), is preferred for vaginal insertion as it promotes relaxation of the perineal muscles, facilitating easier and less painful insertion. The prone position is contraindicated because it increases intra-abdominal pressure and makes accessing the vaginal opening difficult, hindering proper placement of the suppository.

Choice C rationale

Water-soluble lubricant, not petroleum jelly, should be applied to the suppository or the gloved finger to reduce friction and minimize irritation during insertion. Petroleum jelly is an oil-based product that can break down the latex in some gloves or condoms and is not easily absorbed, potentially interfering with the medication's dissolution and absorption rate.

Choice D rationale

The suppository should be inserted approximately 7.5 to 10 cm (3 to 4 inches) into the vaginal canal, aiming for the posterior fornix, to ensure it rests deep within the vagina. Inserting only 5 cm (2 inches) is insufficient, as the suppository may be expelled or not reach the areas of the vaginal mucosa necessary for effective systemic or local antifungal treatment.

Choice A rationale: A fundal height of 27 cm at 21 weeks gestation exceeds the expected range. Normally, fundal height in centimeters should approximate gestational age between 20 and 36 weeks, with a ±2 cm margin. At 21 weeks, a fundal height of 19–23 cm is acceptable. A measurement of 27 cm suggests possible fetal macrosomia, polyhydramnios, or gestational diabetes, especially in a client with elevated glucose levels and obesity. This warrants follow-up.

Choice B rationale: Fetal heart tones of 145/min fall within the normal range of 110 to 160 beats per minute. This rate reflects appropriate fetal autonomic regulation and oxygenation. Variability in fetal heart rate is expected and indicates a healthy intrauterine environment. No arrhythmia or bradycardia is present. Therefore, this finding does not require follow-up and supports normal fetal well-being at this gestational age.

Choice C rationale: A 1-hour glucose level of 220 mg/dL following a 100-g oral glucose load exceeds the threshold of less than 180 mg/dL. This result indicates impaired glucose tolerance and supports the diagnosis of gestational diabetes mellitus (GDM). GDM increases risks for fetal macrosomia, shoulder dystocia, and neonatal hypoglycemia. Follow-up is required to initiate dietary management, glucose monitoring, and possibly pharmacologic therapy to prevent maternal and fetal complications.

Choice D rationale: A 3-hour glucose level of 142 mg/dL exceeds the normal range of 70 to 115 mg/dL. This result confirms abnormal glucose metabolism and supports the diagnosis of gestational diabetes. The 3-hour value reflects delayed glucose clearance and persistent hyperglycemia. This finding, in conjunction with other elevated values, meets criteria for GDM and necessitates follow-up for glycemic control, nutritional counseling, and fetal surveillance to mitigate adverse outcomes.

Choice E rationale: A blood pressure of 140/88 mm Hg meets the threshold for gestational hypertension, defined as systolic ≥140 mm Hg or diastolic ≥90 mm Hg after 20 weeks gestation. Although the client denies symptoms of preeclampsia, such as headache or visual changes, her history of chronic hypertension and obesity increases risk. Continued monitoring and possible adjustment of antihypertensive therapy are warranted to prevent progression to preeclampsia or eclampsia.

Choice F rationale: Denial of headaches, visual disturbances, and epigastric pain suggests absence of preeclampsia symptoms. These symptoms reflect end-organ involvement and vasospasm in severe hypertensive disorders. Their absence supports stable maternal status. However, clinical vigilance remains important due to the client’s elevated blood pressure and risk factors. At this time, no follow-up is required solely based on symptom denial.