A nurse is caring for a client who is 2 hr postoperative. Which of the following findings should the nurse report to the provider?

Rationale:
A. "Take your diuretic medication with your evening meal.": Taking diuretics in the evening can increase nocturia and exacerbate urinary incontinence. Diuretics are typically scheduled in the morning to minimize nighttime urination.

B. "Limit your fluid intake to 500 milliliters per day.": Severely restricting fluids can lead to dehydration and concentrated urine, which may irritate the bladder and worsen urge incontinence. Adequate hydration should be maintained while managing bladder habits.

C. "Plan to urinate every 3 hours while you are awake.": Scheduled voiding or bladder retraining involves establishing regular intervals for urination. Urinating every 2–3 hours helps the bladder gradually increase capacity and reduces episodes of urge incontinence by promoting control.

D. "Decrease your intake of cranberry juice.": Cranberry juice may acidify urine but is not a primary intervention for bladder retraining. Avoiding irritants like caffeine or alcohol is more relevant for managing urge incontinence.

Rationale for Correct Choices

• Seizures: The client’s BP of 166/110 mm Hg, +3 pitting edema, hyperreflexia (4+), and 3+ proteinuria are hallmark findings of severe preeclampsia, which places the client at high risk for progression to eclampsia (seizures). Cerebral edema and vasospasm associated with preeclampsia can precipitate convulsions if untreated.

• Placental abruption: Severe hypertension causes vasoconstriction and endothelial damage in uteroplacental vessels, predisposing the placenta to premature separation. This can lead to fetal distress, decreased movement, and potential maternal hemorrhage, both consistent with placental abruption risk in preeclampsia.

Rationale for Incorrect Choices

• Hypoglycemia: This condition is not related to preeclampsia; it more commonly occurs in clients with diabetes or from medication effects such as insulin overuse.

• Cervical insufficiency: This condition involves painless cervical dilation leading to preterm birth, unrelated to hypertension or proteinuria.

• Heart failure: Although hypertension increases cardiac workload, the current findings (normal heart rate, no dyspnea, clear lungs) do not indicate heart failure in this client.