A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse?

Choice A reason: Anxiety due to hospitalization is not a likely cause of the signs reported by the patient. Anxiety can cause some symptoms, such as headache, palpitations, or sweating, but it does not cause visual changes or epigastric pain. Anxiety is also not a common complication of pregnancy-induced hypertension, which is a condition characterized by high blood pressure and protein in the urine.

Choice B reason: Effects of magnesium sulfate are not a likely cause of the signs reported by the patient. Magnesium sulfate is a medication used to prevent seizures and lower blood pressure in patients with pregnancy-induced hypertension. It can cause some side effects, such as flushing, nausea, or drowsiness, but it does not cause headache, visual changes, or epigastric pain. In fact, magnesium sulfate can help relieve these symptoms by reducing the cerebral edema and vasospasm caused by pregnancy-induced hypertension.

Choice C reason: Worsening disease and impending convulsion are the most likely cause of the signs reported by the patient. These signs indicate that the patient is developing severe preeclampsia or eclampsia, which are life-threatening complications of pregnancy-induced hypertension. Preeclampsia is characterized by high blood pressure, protein in the urine, and signs of organ damage, such as headache, visual changes, epigastric pain, or decreased urine output. Eclampsia is the occurrence of seizures in a patient with preeclampsia. These conditions can lead to stroke, bleeding, placental abruption, or fetal distress, and require immediate medical attention.

Choice D reason: Gastrointestinal upset is not a likely cause of the signs reported by the patient. Gastrointestinal upset can cause some symptoms, such as nausea, vomiting, or abdominal pain, but it does not cause headache, visual changes, or epigastric pain. Gastrointestinal upset is also not a common complication of pregnancy-induced hypertension, which is a condition that affects the blood vessels and organs, not the digestive system.

Choice A reason: Fetal sleep cycles are a normal physiological cause of decreased variability in the FHR, which is the fluctuation of the baseline FHR above and below 2 cycles per minute. Fetal sleep cycles usually last 20 to 40 minutes and do not affect the fetal well-being.

Choice B reason: Umbilical cord compression is an abnormal cause of decreased variability in the FHR, as it reduces the blood flow and oxygen delivery to the fetus. It can also cause variable decelerations, which are abrupt decreases in the FHR below the baseline.

Choice C reason: Altered cerebral blood flow is an abnormal cause of decreased variability in the FHR, as it indicates a compromise in the fetal central nervous system. It can also cause late decelerations, which are gradual decreases in the FHR after the peak of a contraction.

Choice D reason: Fetal hypoxemia is an abnormal cause of decreased variability in the FHR, as it reflects a severe lack of oxygen in the fetal blood. It can also cause sinusoidal pattern, which is a smooth, undulating waveform in the FHR.