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A 33-Year-Old Primigravida at 32 Weeks Gestation Comes to the Office

question 700

Multiple Choice

A 33-year-old primigravida at 32 weeks gestation comes to the office due to severe generalized itching that is most intense on her hands and feet. Her pregnancy has been uncomplicated so far. The patient has no other medical conditions and her only medication is a daily prenatal vitamin. She does not use tobacco, alcohol, or illicit drugs.
Blood pressure is 106/60 mm Hg, pulse is 56/min, and respirations are 12/min. Skin examination shows excoriations on her forearms and anterior shins. The abdomen is nontender and there is no hepatosplenomegaly. The remainder of the physical examination is within normal limits.
Laboratory results are as follows:
Viral hepatitis panel is negative. Abdominal ultrasound reveals normal liver echogenicity and no dilated bile ducts.
Which of the following is the most appropriate next step in management of this patient?

Definitions:

Amphetamines

A class of stimulant drugs that can enhance the nervous system, often used medicinally for ADHD and narcolepsy but also abused recreationally.

Opiate Metabolites

The breakdown products formed when the body processes opiates, useful in detecting opiate use through various testing methods.

Heart Rate

The number of times the heart beats per minute, a vital indicator of cardiovascular health and physical condition.

Problem Conceptualization

This term involves understanding and defining a problem in detail, including its nature, causes, and potential solutions, within a specific context.