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
Gestational hypertension is not the most likely diagnosis for the client. Gestational hypertension is a condition where the blood pressure is elevated after 20 weeks of gestation, without any signs of proteinuria or end-organ damage. The client has a history of chronic hypertension for 5 years, which means that the hypertension existed before the pregnancy. The client also has proteinuria, which is a sign of preeclampsia.

Choice B rationale
Chronic hypertension with superimposed preeclampsia is the most likely diagnosis for the client. Chronic hypertension with superimposed preeclampsia is a condition where the blood pressure is elevated before 20 weeks of gestation, and the hypertension worsens or the proteinuria develops or increases after 20 weeks of gestation. The client has a history of chronic hypertension for 5 years, and the blood pressure is very high at 34 weeks of gestation. The client also has 3+ proteinuria, which indicates severe preeclampsia.

Choice C rationale
Eclampsia is not the most likely diagnosis for the client. Eclampsia is a condition where the preeclampsia progresses to cause seizures or coma in the pregnant woman. The client has no signs of seizures or coma, but only signs of preeclampsia.

Choice D rationale
HELLP syndrome is not the most likely diagnosis for the client. HELLP syndrome is a condition where the preeclampsia causes hemolysis, elevated liver enzymes, and low platelets in the pregnant woman. The client has no signs of hemolysis, liver damage, or thrombocytopenia, but only signs of preeclampsia.

Choice A rationale
Fetal head compression is not the cause of late decelerations. Fetal head compression occurs when the fetal head is pressed against the maternal pelvis or cervix during labor. This can cause early decelerations, which are symmetrical decreases in the fetal heart rate that coincide with the uterine contractions.

Choice B rationale
Umbilical cord compression is not the cause of late decelerations. Umbilical cord compression occurs when the umbilical cord is squeezed between the fetal body and the maternal pelvis or uterine wall during labor. This can cause variable decelerations, which are abrupt and irregular decreases in the fetal heart rate that vary in timing and duration.

Choice C rationale
Uteroplacental insufficiency is the cause of late decelerations. Uteroplacental insufficiency occurs when the blood flow and oxygen delivery to the placenta are reduced during labor. This can cause late decelerations, which are symmetrical decreases in the fetal heart rate that begin after the peak of the uterine contractions and return to baseline after the contractions end.

Choice D rationale
Maternal bradycardia is not the cause of late decelerations. Maternal bradycardia is a slow maternal heart rate that can be caused by various factors such as medication, hypotension, or vagal stimulation. Maternal bradycardia can affect the fetal heart rate, but it does not cause a specific pattern of decelerations.