The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy.
The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is:.

Choice A rationale:
Fever as high as 40° C (104° F). Fever is not typically a common sign or symptom of chronic otitis media with effusion (OME). Chronic OME is characterized by the presence of fluid in the middle ear without signs of acute infection. While fever might occur in acute otitis media, it is not a typical feature of chronic OME.
Choice B rationale:
Severe pain in the ear. Severe pain in the ear is more commonly associated with acute otitis media rather than chronic otitis media with effusion. Chronic OME usually presents with a sensation of fullness or hearing loss in the affected ear due to the accumulation of fluid in the middle ear, but it does not cause severe ear pain.
Choice C rationale:
Nausea and vomiting. Nausea and vomiting are not typical signs or symptoms of chronic otitis media with effusion. These symptoms are more likely to occur in conditions affecting the inner ear or vestibular system, not in chronic OME.
Choice D rationale:
A feeling of fullness in the ear. A feeling of fullness in the ear is a common sign of chronic otitis media with effusion. The accumulation of fluid in the middle ear can cause a sense of fullness or pressure in the affected ear. This sensation might be accompanied by mild hearing loss.

Choice A rationale:

Afterbirth hemorrhage, or postpartum hemorrhage (PPH), is a significant concern after childbirth. One of the common causes is retained placental fragments. When placental tissue is not completely expelled after delivery, it can lead to continuous bleeding. This condition requires prompt medical intervention, often through uterine exploration and removal of the retained tissue.

Choice B rationale:

Unrepaired vaginal lacerations can cause bleeding, but they are usually identified and repaired immediately after delivery. In this case, the woman gave birth 4 hours ago, so unrepaired lacerations would have been addressed during the delivery process.

Choice C rationale:

Uterine atony, which is the lack of normal uterine muscle tone, can cause postpartum hemorrhage. However, in this scenario, the woman was given Pitocin, which is an oxytocic medication used to prevent or treat uterine atony by inducing uterine contractions. Therefore, uterine atony is less likely to be the cause in this case.

Choice D rationale:

Puerperal infection, also known as postpartum infection, can cause fever, uterine tenderness, and foul-smelling discharge. While it can lead to complications, it is not the most likely cause of significant bleeding in this situation.