The nurse is performing assessments of several clients during routine prenatal visits. Which client should the nurse discuss with the health care provider first?

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Intrahepatic cholestasis of pregnancy is a liver disorder exclusive to pregnancy that manifests with intense, generalized itching but no rash. Itching often involves the hands and feet and worsens at night. This condition increases the risk of intrauterine fetal demise and requires priority assessment by the health care provider (Option C). Management includes laboratory testing (eg, elevated bile acids), fetal surveillance (eg, biophysical profile, nonstress test), medication (ie, ursodeoxycholic acid), and labor induction around 37 weeks gestation. Intrahepatic cholestasis of pregnancy begins to resolve after birth. (Option A) Chloasma (ie, melasma, mask of pregnancy) is a hormonally stimulated increase in pigmentation over the bridge of the nose and cheeks that usually appears in the second trimester; it is benign and fades postpartum. (Option B) Fleshy, nontender bumps on genital/anal areas are characteristic of condylomata acuminata (ie, anogenital warts) caused by human papillomavirus. Treatments (eg, trichloroacetic acid) are available for removal of warts in pregnancy, but it is not a priority. (Option D) Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a dermatologic complication that causes discomfort but is not harmful to the client. Pruritic, raised lesions form within abdominal striae, spare the umbilicus, and may spread to the thighs, arms, legs, and back. Educational objective: Intrahepatic cholestasis of pregnancy is a liver disorder exclusive to pregnancy that manifests with intense, generalized itching but no rash. The condition requires priority assessment and intervention (eg, bile acid testing, fetal surveillance, ursodeoxycholic acid) due to an increased risk of fetal demise.

The Nurse Is Performing Assessments of Several Clients During Routine