The nurse has reviewed the Vital Signs at 1000.

Which of the following statements should the nurse include when reinforcing teaching to the client following the procedure? Select all that apply.

A. Attach a blood pressure cuff to the client's upper arm: A blood pressure cuff is not involved in obtaining a 12-lead ECG. Although blood pressure may be assessed separately, it is not part of the ECG procedure itself and would not aid in capturing accurate cardiac electrical activity.

B. Assist the client to the orthopneic position: The orthopneic position, which involves leaning forward, is used to ease breathing difficulties, not for ECG recording. For an ECG, the client should be lying flat or in a semi-reclined supine position to ensure consistent and accurate electrode placement.

C. Tell the client to expect a mild stinging sensation during the test: A 12-lead ECG is a painless, non-invasive procedure. Electrodes are applied to the skin's surface to measure electrical activity; there should be no pain or stinging involved unless the skin is abraded during preparation.

D. Instruct the client to remain as still as possible during the recording: Movement can cause artifacts on the ECG tracing, making it difficult to interpret accurately. Instructing the client to stay still helps ensure a clean recording and minimizes interference from muscle tremors or motion.

• Deep tendon patellar reflex: The client's deep tendon reflexes improved from being hyperreflexive at 4+ to normal at 2+ without clonus on Day 2. This is a positive sign because hyperreflexia increases seizure risk in preeclampsia, and normalization indicates stabilization of neurological irritability.
• Blood pressure: Although still elevated, the blood pressure decreased from 166/110 mm Hg to 152/90 mm Hg by Day 2. While not normal yet, the trend toward lower values represents improvement in controlling the severe hypertension associated with preeclampsia.
• Heart rate: The client's heart rate increased slightly from 72/min to 90/min. While still within normal range, this change reflects a more responsive and stable cardiovascular status, and there are no signs of bradycardia or distress, supporting mild improvement.
• Edema: The client continues to have +3 pitting edema bilaterally, with no reported reduction compared to the initial assessment. Persistent severe edema suggests that fluid balance issues from preeclampsia have not yet improved and still require active management.