A nurse is performing an annual wellness exam on an 8-year-old child whose last exam was one year ago. Which of the following findings should the nurse report to the provider?

Rationale for Correct Choices:

• Seizures: The client presents with severe preeclampsia, indicated by BP >160/110 mm Hg, 3+ proteinuria, hyperreflexia (patellar reflex 4+), and persistent headache. These are strong predictors of progression to eclampsia, which is marked by seizures.
• Placental Abruption: Severe hypertension increases the risk of placental abruption due to vascular compromise in the uteroplacental circulation. Decreased fetal movement may be an early warning sign of impaired placental perfusion or separation.

Rationale for Incorrect Choices:

• Cervical Insufficiency: This is a painless cervical dilation often leading to second-trimester loss, unrelated to hypertension or proteinuria. The client is in the third trimester with no signs of cervical changes.
• Hypoglycemia: The client has no history of diabetes, glucose intolerance, or related symptoms. Her urine glucose was only trace, and no medications suggest insulin use.
• Heart Failure: No signs of pulmonary congestion, dyspnea, or elevated heart rate are present. Oxygen saturation is normal, and breath sounds are not mentioned as abnormal, making CHF unlikely at this stage.

Rationale:

A. Avoid talking to the client about the newborn: Avoidance may intensify the client’s sense of isolation and loss. Acknowledging the newborn and offering opportunities to express emotions helps validate the grief and supports emotional healing.

B. Offer to take pictures of the newborn for the client: Creating mementos such as photographs allows the client and family to honor the baby’s memory and supports healthy grieving. These keepsakes may become meaningful in the healing process over time.

C. Assure the client that she can have additional children: While well-intended, this statement can minimize the significance of the loss. Grief must be acknowledged in the present without shifting focus to future pregnancies, which may feel dismissive.

D. Discourage the client from allowing friends to see the newborn: Families should be supported in making choices about how they wish to say goodbye. Discouraging this may interfere with personal grieving preferences and disrupt closure.