A nurse is assessing self-management skills for a client who has preeclampsia without severe features. Which of the following client statements should the nurse recognize as an indication the client is coping effectively?

Rationale for Correct Findings:

• Temperature 38.2° C (100.8° F): Fever in a postpartum client may indicate infection such as endometritis, mastitis, or wound infection. Early detection is essential to prevent progression to sepsis, especially after cesarean birth and prolonged rupture of membranes.

• Heart rate 104/min: Tachycardia in the postpartum period may reflect infection, pain, or hypovolemia. Coupled with fever and leukocytosis, it indicates systemic inflammatory response requiring urgent evaluation.

• Client reports feeling unwell: Subjective complaints of malaise can be an early indicator of infection or postpartum complications. When combined with objective findings like fever and elevated WBC, it requires prompt follow-up.

• WBC count 33,000/mm³: Significantly elevated leukocytes indicate a severe inflammatory or infectious process. Immediate assessment and intervention are necessary to prevent progression to sepsis.

• Uterus firm at 1 cm above the umbilicus and tender to palpation; fundus boggy but firmed with massage: A boggy fundus and uterine tenderness can indicate uterine atony or early postpartum infection. These findings, especially with elevated temperature and WBC, require urgent monitoring and intervention.

• Moderate amount of dark brown, foul-smelling lochia: Foul-smelling lochia is abnormal and may signal endometritis, particularly after cesarean delivery and prolonged rupture of membranes. This requires prompt evaluation and potential initiation of antibiotics.

Rationale for Incorrect Findings:

• Breasts firm, heavy, and warm with moderate nipple discomfort while breastfeeding: These are expected findings related to milk engorgement. They are typical postpartum changes and can be managed with frequent breastfeeding or expressing milk.

• Surgical incision well approximated with slight edema, no redness or drainage: Slight edema at the incision site is normal post-cesarean. Absence of redness, warmth, or drainage indicates no infection requiring urgent intervention.

• BP 108/70 mm Hg: Blood pressure is within the acceptable range for a postpartum client and does not indicate immediate concern.

• Respiratory rate 18/min: This is within normal limits for an adult and does not require urgent intervention.

• SaO2 97% on room air: Oxygen saturation is within normal range and indicates adequate oxygenation, not requiring immediate follow-up.

• Hemoglobin 11.1 g/dL: This value is within normal postpartum limits, indicating no acute anemia or need for immediate intervention.

Rationale:
A. "Store and eat luncheon deli meats cold while pregnant.": Cold deli meats can harbor Listeria monocytogenes, which can cause listeriosis and increase the risk of miscarriage or fetal infection. Pregnant clients should heat deli meats until steaming before consumption to reduce this risk.

B. "Wash all fruits thoroughly before consumption during pregnancy.": Washing fruits removes dirt, bacteria, and potential contaminants such as Listeria or Toxoplasma, reducing the risk of food-borne illness. This is a key preventive measure for maintaining maternal and fetal health.

C. "Consumption of raw fish is safe during pregnancy if done in moderation.": Raw fish can contain parasites and bacteria such as Salmonella, or Toxoplasma. Pregnant clients should avoid raw or undercooked fish entirely to prevent serious infections that can harm the fetus.

D. "Food-borne illnesses are more difficult to contract while pregnant.": Pregnancy actually increases susceptibility to certain food-borne illnesses due to immunologic changes. Pregnant clients should follow strict food safety measures to protect both maternal and fetal health.