A nurse is caring for a client who is requesting assistance with smoking cessation. The nurse should anticipate a prescription for which of the following medications?

Rationale for correct choices:

• Deep tendon reflexes 2+ bilaterally: DTRs decreased from 3+ to 2+, indicating reduced hyperreflexia. Hyperreflexia is a hallmark of preeclampsia and HELLP syndrome; improvement suggests that neuromuscular excitability and central nervous system irritability are stabilizing. Monitoring DTRs helps evaluate treatment effectiveness and risk reduction for complications.

• Oxygen saturation (SaO₂) 95% on 2 L nasal cannula: Oxygenation is within acceptable limits for a patient on supplemental oxygen. Maintaining adequate maternal oxygenation supports fetal perfusion and reduces hypoxic stress. Improved oxygen saturation reflects better respiratory status and cardiovascular stability compared with prior readings (SaO₂ 92–94%).

• Respiratory rate 18/min: The client’s respiratory rate is within normal limits, improving from earlier tachypnea (24/min). Stabilization of respiratory rate indicates reduced distress, better oxygenation, and improved overall maternal status, which contributes to safer outcomes for both mother and fetus.

• Blood pressure 146/96 mm Hg: At 1400, the client’s blood pressure had spiked to a very dangerous 170/112 mm Hg (severe hypertension). The decrease to 146/96 mm Hg by 1800 indicates that medical interventions are successfully lowering the pressure toward a safer range.

Rationale for incorrect choices:

• Temperature 38.3° C (101° F): The client’s temperature is elevated, indicating fever. Fever does not reflect improvement and may signal infection, inflammation, or other complications. Ongoing assessment and intervention are required to address the cause of hyperthermia.

• Urine output 40 mL: A single low urine output reading suggests oliguria, which is concerning in preeclampsia or HELLP syndrome. Adequate renal perfusion is essential; this value does not indicate improvement and requires ongoing monitoring.

• Heart rate 58/min: Bradycardia may be related to medications, vagal stimulation, or underlying cardiovascular changes. While it is a change from prior tachycardia, bradycardia itself is not an indicator of improvement and may require further evaluation.

A. A hospital volunteer leaves the unit with the newborn to allow caregiver to rest: Hospital volunteers are not authorized to transport newborns, especially off the unit. Removing a newborn without proper clinical authorization represents a significant security risk and requires immediate initiation of a security alert to prevent potential abduction.

B. Another nurse on the unit requests to take the newborn to the nursery to obtain newborn screening: A licensed nurse transporting a newborn for required screening is an expected and appropriate practice. This follows standard hospital protocol and does not indicate a security concern when proper identification procedures are followed.

C. An assistive personnel weighs and bathes the newborn in an empty client room: Assistive personnel may perform routine newborn care under facility policy and nursing delegation. While supervision and proper identification are required, this situation alone does not necessitate a security alert.

D. The caregiver and newborn have matching hospital identification bracelets: Matching identification bands indicate that correct newborn identification procedures are in place. This supports infant safety and does not represent a situation requiring security intervention.