A nurse is providing teaching to a client who gave birth 8 hr ago and is exclusively breastfeeding. Which of the following information should the nurse include?

Rationale for Correct Choices:

• DTR 2+ bilaterally: The deep tendon reflexes improved from 1+ earlier (indicating possible magnesium toxicity) to 2+, which falls within the normal range of 1+ to 3+. This suggests better neuromuscular function and reduced magnesium side effects.
• Urine output 40 mL/hr: Increased from a low 20 mL/hr at 1400 to 40 mL/hr at 1800, above the normal minimum urine output (>30 mL/hr). This reflects improved renal perfusion and fluid balance, crucial for preventing complications in preeclampsia.
• Oxygen saturation 95% on 2 L nasal cannula: Oxygen saturation stabilized at 95%, which is the lower limit of normal (95–100%). Previously it was 92% on room air, indicating improved oxygenation with supplemental oxygen support.
• Respiratory rate 18/min: Improved from shallow respirations at 14/min to 18/min, which falls within the normal adult range (12–20/min). This indicates better respiratory effort and gas exchange.
• Blood pressure 146/96 mm Hg: Decreased from a hypertensive crisis level of 170/112 mm Hg at 1400 to 146/96 mm Hg, showing effective blood pressure management though still above the ideal (<120/80 mm Hg). This reduction lowers the risk of severe complications.

Rationale for Incorrect Choices:

• Temperature 38.3° C (101° F): Elevated above the normal range (36.5–37.5° C), this fever suggests possible infection or inflammatory response and does not represent clinical improvement. It requires further evaluation and treatment.
• Heart rate 58/min: Decreased from 80/min to 58/min, falling below the normal range of 60–100/min. This bradycardia may be a sign of magnesium toxicity or cardiovascular suppression and requires close monitoring.

• Prenatal anemia: Decreases the oxygen-carrying capacity of the blood, impairing tissue oxygenation and immune response. This weakened immune status makes the client more vulnerable to infections during the postpartum period and delays healing.
• High parity: Increases the risk of uterine atony because repeated pregnancies and deliveries cause stretching and weakening of the uterine muscle. This reduces the uterus’s ability to contract effectively after birth, increasing the risk of postpartum hemorrhage.
• Polyhydramnios; Leads to overdistension of the uterus during pregnancy, which can impair uterine muscle tone and its ability to contract properly after delivery. This overdistension is a common cause of uterine atony and related postpartum bleeding.
• Prolonged rupture of membranes: Allows bacteria from the vagina to ascend into the uterus over time, significantly increasing the risk of infection such as chorioamnionitis or postpartum endometritis. The longer the membranes are ruptured before delivery, the greater the infection risk.