A nurse is reinforcing teaching about risk factors for preeclampsia with a group of clients who are pregnant. Which of the following risk factors should the nurse include in the teaching?

The correct answer is d. "I may develop discoloration on my cheeks from hormonal changes."

Choice a rationale:

• Statement:"I should expect to have burning when I urinate during the third trimester."
• Rationale:This statement is incorrect.Burning during urination is not a normal physiological change of pregnancy.It may be a sign of a urinary tract infection (UTI),which is a common infection during pregnancy.If a pregnant client experiences burning during urination,she should report it to her healthcare provider for evaluation and treatment.

Choice b rationale:

• Statement:"I may have an infection if I develop a dark line in the middle of my abdomen."
• Rationale:This statement is incorrect.A dark line in the middle of the abdomen,known as the linea nigra,is a normal physiological change of pregnancy.It is caused by hormonal changes that increase melanin production in the skin.The linea nigra typically appears in the second trimester and fades after delivery.

Choice c rationale:

• Statement:"I should expect my fingers and face to be swollen."
• Rationale:This statement is partially correct.Some swelling in the hands and face is common during pregnancy,especially in the third trimester.This is due to fluid retention caused by hormonal changes.However,excessive swelling,particularly in the hands and face,can be a sign of preeclampsia,a serious pregnancy complication.It's important to report any significant swelling to a healthcare provider.

Choice d rationale:

• Statement:"I may develop discoloration on my cheeks from hormonal changes."
• Rationale:This statement is correct.Hormonal changes during pregnancy can cause a variety of skin changes,including melasma,which is a brownish discoloration that often appears on the cheeks,forehead,and nose.Melasma is more common in women with darker skin tones and usually fades after delivery.

Rationale:

A. Tachycardia is not a common or direct adverse effect of epidural anesthesia itself. While a rapid heart rate may occur secondary to maternal anxiety or as a compensatory response to hypotension, it is not the primary physiological marker for epidural complications. Heart rate typically remains stable or may decrease slightly as pain is relieved and sympathetic activity is modulated.

B. Fever is a documented potential adverse effect associated with epidural anesthesia, particularly during labor. The exact mechanism is multifactorial, potentially involving altered thermoregulation, reduced heat dissipation due to sympathetic blockade, or a non-infectious inflammatory response. Clinicians must distinguish this pharmacological pyrexia from maternal infection to ensure appropriate neonatal and maternal management following the delivery.

C. Tachypnea, or an increased respiratory rate, is generally not associated with epidural anesthesia. In fact, if the anesthesia level rises too high, it can lead to respiratory depression or a decreased rate due to the blockade of intercostal muscle nerves. Effective epidural analgesia usually promotes a more relaxed, normal breathing pattern by successfully alleviating the physiological stress and hyperventilation caused by acute pain.

D. Hypertension is the opposite of the expected vascular response to epidural anesthesia. The local anesthetic typically causes a sympathetic blockade, leading to peripheral vasodilation and a significant risk of maternal hypotension rather than high blood pressure. Monitoring blood pressure is a critical nursing priority because decreased systemic vascular resistance can compromise placental perfusion and lead to fetal heart rate decelerations.