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Question

Difficulty: MediumAnte/Intra/Postpartum and Newborn Care

A telephone triage nurse at an obstetrical practice is reviewing voicemail messages left by four different clients. Which client condition requires the most immediate callback?

  1. A
    A client at 9 weeks of gestation reporting daily morning nausea and frequent urination
  2. B
    A client at 38 weeks of gestation reporting a thick, pink-tinged vaginal discharge
  3. A client at 32 weeks of gestation reporting a persistent, throbbing headache unresolved by acetaminophenAnswer
  4. D
    A client at 34 weeks of gestation reporting irregular, painless uterine tightening that stops with walking

Answer

The client at 32 weeks of gestation reporting a persistent, throbbing headache unresolved by acetaminophen requires the most immediate callback.
A persistent, severe headache that does not respond to typical over-the-counter analgesics during the second or third trimester is a cardinal sign of worsening preeclampsia. This symptom indicates increasing cerebral edema and impending eclampsia (seizures), which is a life-threatening emergency requiring immediate medical intervention to protect the mother and fetus.

Step-by-Step Solution

1
Analyze each client's reported symptoms against the expected physiological changes of pregnancy.
Three clients report normal findings, while one reports a pathological sign.
To differentiate between routine pregnancy discomforts and true obstetrical emergencies.
2
Evaluate the severe headache at 32 weeks of gestation.
This is identified as a classic symptom of severe preeclampsia.
Preeclampsia involves systemic vasospasm, leading to cerebral edema and severe headache, which poses a high risk for seizures (eclampsia).
3
Apply prioritization frameworks such as ABCs (Airway, Breathing, Circulation) or 'acute versus chronic'.
The risk of eclamptic seizures represents an immediate, acute threat to both maternal and fetal well-being.
Clients with life-threatening, acute conditions must be prioritized for callback and evaluation over those with expected, benign symptoms.

Key Concept

Prioritization of obstetrical emergencies and recognition of severe preeclampsia symptoms
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Topics

Ante/Intra/Postpartum and Newborn Care

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