A nurse is reviewing the results of a 1-hr glucose screening test for a client who is at 24 weeks of gestation. The client's glucose value is 130 mg/dL. Which of the following actions should the nurse take?

A. Elevated blood pressure is typically associated with gestational hypertension or preeclampsia rather than hyperemesis gravidarum. In hyperemesis, the significant fluid loss through protracted vomiting more commonly leads to hypovolemia and a subsequent decrease in systemic blood pressure. While compensatory tachycardia may occur, hypertension is not a direct scientific expectation for this clinical condition.

B. Leukopenia, which is a decrease in the white blood cell count, is not a typical finding in clients suffering from hyperemesis gravidarum. Hemoconcentration caused by severe dehydration may actually result in a relative increase in various laboratory values, including hematocrit and occasionally white cell counts. There is no physiological mechanism within this disorder that causes the bone marrow suppression required for leukopenia.

C. Hydramnios, or excessive amniotic fluid volume, is generally associated with fetal anomalies or maternal diabetes rather than severe vomiting. Hyperemesis gravidarum is characterized by a state of maternal fluid volume deficit rather than an excess of amniotic fluid. In severe, untreated cases, maternal dehydration might actually lead to decreased placental perfusion and a potential reduction in amniotic fluid.

D. Ketonuria is a critical finding in hyperemesis gravidarum that indicates the body has shifted to an anaerobic metabolic state. Because the client cannot retain sufficient carbohydrates for energy, the body begins catabolizing adipose tissue to produce fuel, resulting in the accumulation of ketone bodies. The presence of these ketones in the urine confirms that the client is experiencing metabolic starvation and requires immediate intervention.

A) Incorrect- While notifying the provider might be necessary, addressing bladder distention takes precedence in this scenario.
B) Incorrect- Administering an analgesic might be indicated for pain relief, but addressing bladder distention is the priority.
C) Correct - Assisting the client to empty her bladder is the first action to take. A full bladder can prevent the uterus from contracting properly and can lead to excessive bleeding.
D) Incorrect- Monitoring perineal pads for clots is important but not the first action to take when bladder distention is present.