A nurse in a provider's office is caring for a client who is at 34 weeks of gestation and at risk for placental abruption. The nurse should recognize that which of the following is the most common risk factor for abruption?

Choice A rationale
Gestational hypertension is not the most likely diagnosis for the client. Gestational hypertension is a condition where the blood pressure is elevated after 20 weeks of gestation, without any signs of proteinuria or end-organ damage. The client has a history of chronic hypertension for 5 years, which means that the hypertension existed before the pregnancy. The client also has proteinuria, which is a sign of preeclampsia.

Choice B rationale
Chronic hypertension with superimposed preeclampsia is the most likely diagnosis for the client. Chronic hypertension with superimposed preeclampsia is a condition where the blood pressure is elevated before 20 weeks of gestation, and the hypertension worsens or the proteinuria develops or increases after 20 weeks of gestation. The client has a history of chronic hypertension for 5 years, and the blood pressure is very high at 34 weeks of gestation. The client also has 3+ proteinuria, which indicates severe preeclampsia.

Choice C rationale
Eclampsia is not the most likely diagnosis for the client. Eclampsia is a condition where the preeclampsia progresses to cause seizures or coma in the pregnant woman. The client has no signs of seizures or coma, but only signs of preeclampsia.

Choice D rationale
HELLP syndrome is not the most likely diagnosis for the client. HELLP syndrome is a condition where the preeclampsia causes hemolysis, elevated liver enzymes, and low platelets in the pregnant woman. The client has no signs of hemolysis, liver damage, or thrombocytopenia, but only signs of preeclampsia.

Choice A rationale
This is correct because a client who has a diagnosis of preeclampsia reports epigastric pain and unresolved headache is the most urgent finding. These are signs of severe preeclampsia, which can progress to eclampsia, a life-threatening condition that involves seizures, coma, and organ damage. The nurse should report this finding to the provider immediately and prepare for the delivery of the fetus and the administration of magnesium sulfate to prevent seizures.

Choice B rationale
This is incorrect because a client who has a diagnosis of preeclampsia has 2+ proteinuria and 2+ patellar reflexes is not the most urgent finding. These are signs of mild preeclampsia, which can be managed with close monitoring, bed rest, and antihypertensive medications. The nurse should report this finding to the provider, but it is not an emergency.

Choice C rationale
This is incorrect because a client who is at 28 weeks of gestation and receiving terbutaline reports fine tremors is not the most urgent finding. These are side effects of terbutaline, a medication that is used to stop preterm labor by relaxing the uterine muscles. The nurse should assess the client's vital signs, blood glucose, and fetal heart rate, and report any abnormal findings to the provider. The nurse should also reassure the client that the tremors are temporary and will subside when the medication is discontinued.

Choice D rationale
This is incorrect because a tearful client who is at 32 weeks of gestation and is experiencing irregular, frequent contractions is not the most urgent finding. These are signs of preterm labor, which can be treated with tocolytic medications, such as terbutaline, to delay the delivery until the fetus is more mature. The nurse should assess the client's cervical dilation, fetal heart rate, and amniotic fluid, and report any abnormal findings to the provider. The nurse should also provide emotional support and education to the client.