Exhibits

A nurse is reviewing the electronic medical record of a client who is at 29 weeks of gestation. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

Rationale:
A. Bradypnea: Clients with end-stage kidney disease are more likely to experience Kussmaul respirations (rapid, deep breathing) as the body attempts to compensate for metabolic acidosis by exhaling excess carbon dioxide. Bradypnea is not a typical finding in renal failure and would indicate a different respiratory issue.

B. Oliguria: As kidney function declines, urine output decreases because the kidneys lose their ability to filter and excrete waste products effectively. Oliguria, or markedly reduced urine output, is a hallmark of end-stage renal disease and contributes to fluid overload.

C. Anemia: The kidneys normally produce erythropoietin, which stimulates red blood cell production. In end-stage kidney disease, decreased erythropoietin production leads to anemia, resulting in fatigue, pallor, and decreased oxygen-carrying capacity.

D. Hypotension: Clients with kidney failure often experience hypertension rather than hypotension due to fluid retention and activation of the renin-angiotensin-aldosterone system. Hypotension would be more characteristic of acute volume depletion, not chronic renal failure.

E. Edema: Impaired kidney function causes sodium and water retention, leading to fluid accumulation in tissues. Peripheral and periorbital edema are common manifestations of end-stage kidney disease due to reduced excretion of excess fluid.

Rationale:
A. The client started working in a parking garage 3 months ago: Working in a parking garage may expose the client to exhaust fumes and carbon monoxide, which are hazardous during pregnancy. This environment increases the risk of fetal hypoxia and warrants further evaluation for occupational safety and potential exposure mitigation.

B. The client is doing 30 min of moderate exercise daily: Moderate exercise during pregnancy is generally safe and encouraged to promote maternal health, improve circulation, and reduce gestational complications. This activity does not indicate unsafe behavior.

C. The client is drinking 2.5 L of water per day: Adequate hydration is recommended during pregnancy to support maternal and fetal circulation, amniotic fluid levels, and overall health. Drinking 2.5 L per day is appropriate and does not require intervention.

D. The client last visited the dentist 4 months ago: Regular dental care is encouraged, but a visit every 4–6 months is generally considered safe and routine. This finding does not indicate unsafe behavior requiring urgent evaluation.