A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding.
A threatened abortion is suspected, and the nurse instructs the client regarding management of care.
Which statement, if made by the client, indicates a need for further education?

Choice A rationale

Encouraging a hands-and-knees position may help rotate a malpositioned fetus or relieve back pain, but it does not directly address hypotonic uterine dysfunction, which is characterized by weak, ineffective contractions. While it can improve maternal comfort and potentially aid in fetal descent if malpositioning is a contributing factor to slow labor progress, it will not augment the strength or frequency of contractions necessary for cervical dilation.

Choice B rationale

Providing a comfortable environment with dim lighting can promote relaxation and potentially enhance the progress of labor in cases of hypertonic uterine dysfunction (uncoordinated, painful contractions). However, in hypotonic dysfunction, the issue is a lack of adequate uterine muscle activity. While comfort measures are always important, they do not directly stimulate stronger contractions.

Choice C rationale

Administering oxytocin is the primary medical intervention for hypotonic uterine dysfunction. Oxytocin is a synthetic hormone that stimulates uterine smooth muscle to contract more frequently and with greater intensity. This augmentation of uterine activity aims to establish an effective labor pattern, leading to cervical dilation and fetal descent when fetopelvic disproportion has been ruled out.

Choice D rationale

Preparing for an amniotomy (artificial rupture of membranes) might be considered to augment labor if the membranes are intact. However, the question states the membranes have already ruptured. Amniotomy can sometimes stimulate contractions by releasing prostaglandins, but it is not the first-line intervention for established hypotonic dysfunction after membrane rupture, and oxytocin is generally more effective in this situation.

Rationale for Correct Condition

Preeclampsia is characterized by hypertension (≥140/90 mm Hg) and proteinuria (≥300 mg/24 hr) or signs of systemic involvement such as headache and edema. The client’s elevated BP, significant proteinuria, headache, hyperreflexia, and pitting edema strongly indicate preeclampsia. The absence of seizures rules out eclampsia, and the gestational age excludes chronic hypertension with superimposed preeclampsia.

Rationale for Correct Actions

Magnesium sulfate prevents seizures by stabilizing neuronal excitability and reducing cerebral vasospasm. It also lowers BP by promoting vascular relaxation. External fetal monitoring detects fetal distress from utero-placental insufficiency caused by preeclampsia-related hypertension and endothelial dysfunction.

Rationale for Correct Parameters

Blood pressure reflects disease progression and response to antihypertensives. Severe hypertension increases the risk of cerebral hemorrhage and placental abruption. Deep tendon reflexes indicate neurological impairment. Hyperreflexia signals worsening preeclampsia, while absent reflexes may indicate magnesium toxicity.

Rationale for Incorrect Conditions

Gestational hypertension lacks proteinuria and systemic symptoms. Chronic hypertension with superimposed preeclampsia requires a pre-existing hypertensive diagnosis. Eclampsia involves seizures, which the client has not reported.

Rationale for Incorrect Actions

Ampicillin is not indicated without infection. Rh immune globulin is unnecessary without Rh incompatibility. Anticoagulants are not first-line for preeclampsia.

Rationale for Incorrect Parameters

Temperature is not directly related to preeclampsia. Petechiae are signs of coagulopathy, not primary indicators. Pruritus is irrelevant unless liver dysfunction is suspected.

Take-Home Points

• Preeclampsia involves multisystem dysfunction with endothelial damage.
• Magnesium sulfate prevents seizures but must be monitored for toxicity.
• Differentiation from gestational hypertension is crucial for management.
• Fetal monitoring is key to detecting early signs of compromise.