A nurse is providing care for a client who is scheduled for electroconvulsive therapy. Which of the following conditions should the nurse identify as an increased risk for complications?

Rationale:

• Polyhydramnios: Excess amniotic fluid stretches the uterus, increasing the risk of uterine atony postpartum because the uterine muscle fibers are overly distended and cannot contract effectively.

• High parity: Multiple prior pregnancies weaken uterine muscle tone over time, predisposing the client to uterine atony after delivery, as the uterus may not contract adequately to control bleeding.

• Prolonged rupture of membranes: Extended rupture (over 24 hours) increases the risk of ascending infections such as chorioamnionitis or endometritis, as the protective barrier of the amniotic sac is compromised.

• Prenatal anemia: Although anemia does not directly cause infection, it reflects a reduced physiological reserve and may predispose the client to infection complications due to decreased oxygen delivery and impaired immune response.

Rationale:
A. Discuss future treatment options with the client's health care surrogate: The client has decision-making capacity and advance directives in place, so the nurse should honor the client’s wishes rather than deferring to the surrogate.

B. Encourage the client to complete a final hemodialysis treatment: Encouraging treatment contradicts the client’s expressed wishes and advance directives, violating the client’s autonomy and right to refuse care.

C. Contact the client's family to discuss the decision: Family input may be supportive, but the client’s decisions take priority. Involving the family without the client’s consent may undermine autonomy.

D. Discuss possible options for discharge with the client: The nurse should focus on supporting the client’s choices, including end-of-life care and hospice or palliative services, and discuss discharge options that align with the client’s wishes.