A nurse is caring for a client who has preeclampsia and is receiving magnesium sulfate. Which of the following clinical findings should the nurse instruct the client to report?

Urination is an important indicator of a newborn's hydration and kidney function. A newborn should urinate at least six times a day, or once every four hours, by the fifth day of life. The urine should be clear or pale yellow and have no strong odor or blood. A newborn who urinates less than six times a day may be dehydrated, have a urinary tract infection, or have a kidney problem .
Therefore, the nurse should instruct the client to monitor her baby's urination and notify the pediatrician if he urinates less than six times a day. The nurse should also teach the client how to prevent dehydration in her baby, such as:
- Feeding the baby frequently, either breast milk or formula, according to his hunger cues and weight gain
- Offering the baby extra fluids in hot weather or when he is sick
- Avoiding giving the baby water, juice, or cow's milk before six months of age
- Checking the baby's diapers for wetness and changing them promptly
- Checking the baby's mouth for dryness and his fontanelle for sunkenness

The other statements are not correct and should not be made by the nurse:
- b) "Swaddle your baby tightly with his legs extended before laying him down to sleep." This is not correct because swaddling a baby too tightly or with his legs extended can cause problems, such as overheating, hip dysplasia, or restricted breathing. The nurse should teach the client how to swaddle her baby safely and comfortably, such as:
- Using a thin blanket that is breathable and does not cover the baby's head or face
- Wrapping the blanket snugly around the baby's chest and arms, but leaving some room for his hips and legs to move freely
- Placing the baby on his back to sleep on a firm and flat surface with no pillows, blankets, or toys
- Stopping swaddling when the baby shows signs of rolling over or breaking free from the blanket

c) "Place triple antibiotic ointment on your baby's umbilical cord twice per day." This is not correct because placing ointment on the umbilical cord can delay its healing and increase the risk of infection. The nurse should teach the client how to care for her baby's umbilical cord until it falls off naturally, usually within one to two weeks after birth, such as:

- Keeping the cord clean and dry by using a cotton swab dipped in water or alcohol to gently wipe around it
- Folding the diaper below the cord to prevent irritation or wetness

- Dressing the baby in loose-fitting clothes that allow air circulation around the cord
- Avoiding bathing the baby in a tub until the cord falls off and heals
- Watching for any signs of infection, such as redness, swelling, pus, foul odor, or bleeding

d) "Retract the foreskin to clean your baby's penis during each bath." This is not correct because retracting the foreskin of a newborn can cause pain, injury, or infection. The foreskin of a newborn is usually attached to the head of the penis (glans) and does not need to be retracted for cleaning. The nurse should teach the client how to clean her baby's penis during each bath, such as:
- Using warm water and mild soap to gently wash the outside of the penis
- Rinsing well and patting dry with a soft towel
- Leaving the foreskin alone and never forcing it back
- Changing diapers frequently and keeping them clean and dry

This is because urine protein of 3+ is a sign of preeclampsia, which is a complication of pregnancy that involves high blood pressure and damage to the kidneys or other organs¹². Preeclampsia can cause serious problems for both the mother and the baby, such as fetal growth restriction, placental abruption, preterm birth, eclampsia, and HELLP syndrome¹². The nurse should report this finding to the provider and monitor the client's blood pressure, reflexes, and fetal well-being. The client may need medication to lower blood pressure and prevent seizures, such as magnesium sulfate or antihypertensives¹².

The other options are not correct because:
a) Deep tendon reflexes of 2+ are normal and do not indicate preeclampsia. Deep tendon reflexes are graded from 0 to 4+, with 2+ being the average response⁶. Increased reflexes (3+ or 4+) may suggest hyperreflexia, which can be a sign of preeclampsia or magnesium toxicity¹⁶.
b) Blood glucose of 110 mg/dL is normal and does not indicate preeclampsia. Blood glucose is the amount of sugar in the blood, and it can vary depending on the time of day, diet, and activity level. The normal range for blood glucose is 70 to 130 mg/dL before meals and less than 180 mg/dL after meals⁷. High blood glucose (hyperglycemia) can be a sign of gestational diabetes, which is a type of diabetes that develops during pregnancy⁷.
d) Hemoglobin of 13 g/dL is normal and does not indicate preeclampsia. Hemoglobin is the protein in red blood cells that carries oxygen throughout the body. The normal range for hemoglobin is 12 to 16 g/dL for women and 14 to 18 g/dL for men⁷. Low hemoglobin (anemia) can be a sign of iron deficiency, bleeding, or infection⁷.