A nurse is assessing a client who has endometritis. Which of the following findings should the nurse expect?

Rationale:

A. "Check your pulse rate for 30 seconds at different times throughout the day.": Clients with pacemakers should check their pulse daily at the same time and for a full minute to ensure the pacemaker is functioning properly. Shorter durations and inconsistent timing may lead to inaccurate assessments.

B. "Limit strenuous physical activity for 8 weeks.” Limiting physical activity, especially involving the upper body, is essential to allow the pacemaker leads to secure in the myocardium. Strain or vigorous movement during the healing phase can displace the leads or disrupt healing.

C. "Remain at least 3 feet away when watching television”: Modern televisions do not emit electromagnetic interference that would affect pacemaker function. There is no need for such distancing, making this instruction inaccurate and unnecessarily restrictive.

D. "Expect to have intermittent, prolonged hiccups.” Persistent hiccups could indicate pacemaker lead displacement or diaphragmatic stimulation and should be reported immediately. They are not an expected or normal finding after pacemaker implantation.

Rationale for correct choices:

• Placental abruption: Hypertension in pregnancy increases the risk of premature separation of the placenta from the uterine wall. In this case, the elevated BP combined with symptoms like right upper quadrant pain and hyperreflexia suggests a potential complication such as placental abruption.
• Hypertension: A blood pressure of 148/94 mm Hg is above the diagnostic threshold for gestational hypertension. When paired with signs like restlessness, headache, and hyperreflexia, it raises concern for preeclampsia, a known risk factor for placental abruption.

Rationale for incorrect choices:

• Placenta previa: Characterized by painless bleeding in the second or third trimester and associated with abnormal placental placement, not hypertension. The client has no bleeding or ultrasound findings consistent with previa.
• Oligohydramnios: Typically linked to fetal or placental insufficiency or rupture of membranes. No findings in this case suggest low amniotic fluid or related complications.
• Spontaneous abortion: This term applies before 20 weeks’ gestation. The client is 30 weeks pregnant with no signs of fetal demise or expulsion, so this condition does not apply.
• Chorioamnionitis: Requires signs of infection such as fever, uterine tenderness, or foul-smelling discharge. The client is afebrile and has clear lung sounds, making infection unlikely.
• Temperature: The recorded temperature is within normal range (37.4°C), so it does not suggest infection or another abnormality requiring urgent follow-up.
• Vomiting: Common in pregnancy and non-specific unless persistent or linked with abnormal labs. Here, it appears as an isolated symptom and does not directly imply risk of abruption.
• Hyperreflexia: While a sign of preeclampsia, it is secondary to hypertension. It supports the presence of a hypertensive disorder but is not the primary cause of abruption.
• Fundal measurement: A fundal height of 29 cm is normal for 30 weeks’ gestation and does not indicate fetal growth restriction or excess fluid that might signal a complication.