The nurse is reviewing the client’s chart.

Click to highlight areas of client history and physical that increase the risk for postpartum hemorrhage.

Client was middle aged and married.

She was in labor for 25 hours and forceps were used to assist with the delivery.

She was given an epidural for anesthesia that was effective.

The labor and delivery nurse reported that the client had a 4th degree laceration, and her pain was currently at a 4 on a 0 to 10 pain scale.

Her vital signs were stable, and she was catheterized for 500 mL of light-yellow urine just prior to delivery.

Her spouse was at the bedside for delivery.

Choice A rationale
Risk for injury related to seizures is an important nursing diagnosis for this client. The client is at risk of seizures due to the severe preeclampsia and the high blood pressure. Seizures can cause injury to the client and the fetus, as well as complications such as aspiration, cerebral hemorrhage, and coma. The nurse should monitor the client's neurological status, administer anticonvulsants as prescribed, and protect the client from injury during a seizure.

Choice B rationale
Impaired gas exchange related to pulmonary edema is an important nursing diagnosis for this client. The client is at risk of pulmonary edema due to the fluid overload and the high blood pressure. Pulmonary edema can impair the gas exchange and oxygen delivery to the client and the fetus, as well as cause respiratory distress, heart failure, and death. The nurse should monitor the client's respiratory status, administer oxygen as prescribed, and restrict the fluid intake.

Choice C rationale
Deficient fluid volume related to diuresis is not an important nursing diagnosis for this client. The client is not at risk of deficient fluid volume, but rather fluid overload. Diuresis is the increased production and excretion of urine, which can cause fluid loss and dehydration. The client does not have any signs of diuresis, such as increased urine output, decreased specific gravity, or weight loss.

Choice D rationale
Ineffective tissue perfusion related to placental abruption is not an important nursing diagnosis for this client. The client is not at risk of placental abruption, but rather uteroplacental insufficiency. Placental abruption is the premature separation of the placenta from the uterine wall, which can cause bleeding, pain, and fetal distress. The client does not have any signs of placental abruption, such as vaginal bleeding, abdominal tenderness, or fetal heart rate abnormalities.

Choice A rationale
This is incorrect because cigarette smoking is not the most common risk factor for abruption. Cigarette smoking can increase the risk of abruption by causing vasoconstriction and reducing placental blood flow, but it is less prevalent and less severe than hypertension.

Choice B rationale
This is correct because hypertension is the most common risk factor for abruption. Hypertension can cause damage to the uterine vessels and lead to bleeding and separation of the placenta from the uterine wall. Hypertension affects about 40% of clients who experience abruption and can be chronic or pregnancy-induced.

Choice C rationale
This is incorrect because blunt force trauma is not the most common risk factor for abruption. Blunt force trauma can cause abruption by applying direct pressure or shear force to the placenta, but it is less common and less predictable than hypertension. Blunt force trauma can result from motor vehicle accidents, falls, or physical abuse.

Choice D rationale
This is incorrect because cocaine use is not the most common risk factor for abruption. Cocaine use can increase the risk of abruption by causing vasoconstriction and uterine contractions, but it is less common and less consistent than hypertension. Cocaine use can also cause other complications, such as fetal growth restriction, preterm labor, or stillbirth.