The nurse has reviewed the Vital Signs, Nurses' Notes, and Provider Notes from 1 week ago.

Select words from the choices below to fill in each blank in the following sentence.

The client is at risk for developing

_____

and

_____

.

Rationale for correct choices

• Placental abruption: The client presents at 30 weeks gestation with sudden onset right upper abdominal pain, headache, nausea, vomiting, facial edema, and elevated blood pressure (148/94 mm Hg). These are classic signs of preeclampsia, which significantly increases the risk of placental abruption. Abruptio placentae involves premature separation of the placenta from the uterine wall, leading to maternal and fetal complications, making close monitoring essential.

• Hypertension: The client’s elevated blood pressure is a hallmark feature of preeclampsia and a key risk factor for placental abruption. Hypertension can impair placental perfusion, increasing the likelihood of placental separation. Prompt identification and management of elevated blood pressure are critical to prevent adverse maternal and fetal outcomes.

Rationale for incorrect choices

• Spontaneous abortion: Spontaneous abortion usually occurs before 20 weeks gestation, whereas this client is at 30 weeks. Current symptoms are more indicative of a hypertensive pregnancy disorder rather than early pregnancy loss, making this diagnosis unlikely.

• Oligohydramnios: There is no indication of reduced amniotic fluid volume on assessment, and fundal height is consistent with gestational age. Oligohydramnios would require ultrasound confirmation and is not suggested by the client’s current presentation.

• Placenta previa: Placenta previa is characterized by painless vaginal bleeding rather than abdominal pain and elevated blood pressure. The client’s symptoms of right upper quadrant pain, hyperreflexia, and hypertension point toward preeclampsia-related complications rather than placenta previa.

• Chorioamnionitis: Chorioamnionitis is an intra-amniotic infection typically associated with fever, uterine tenderness, and maternal/fetal tachycardia. This client is afebrile with normal fetal heart rate, making chorioamnionitis unlikely.

• Hyperreflexia: While hyperreflexia is present, it is a sign of preeclampsia rather than a direct risk factor for placental abruption. It supports the diagnosis but does not independently cause the abruption.

• Temperature: The client’s temperature is within normal limits. Fever is not present and therefore does not contribute to the risk of placental abruption.

• Fundal measurement: The fundal height (29 cm) is appropriate for gestational age and does not indicate a risk factor for placental abruption. Fundal height alone is not predictive of this complication.

• Vomiting: Although present, vomiting is a nonspecific symptom and a secondary sign of preeclampsia. It contributes to maternal discomfort but is not a direct risk factor for placental abruption.

A. Limit the client's opportunities to socialize with others: Social isolation can worsen paranoia and reinforce distrust. Encouraging safe, structured interactions is more therapeutic than limiting socialization.

B. Speak in a neutral tone when addressing the client: A neutral, calm, and nonjudgmental tone helps build trust and reduces the likelihood of misinterpretation of the nurse’s intent, which is critical for clients with paranoid personality disorder who are sensitive to perceived threats or hostility.

C. Mix the medication with the client's food items: Covertly administering medication violates client autonomy and can exacerbate distrust. Clients with paranoid personality disorder are likely to detect such actions, worsening their paranoia and potentially creating legal and ethical issues.

D. Rotate staff members caring for the client: Frequent rotation of staff can undermine trust and reinforce paranoia, as the client may perceive inconsistency as a threat. Consistency in caregivers helps establish therapeutic rapport and promotes adherence to treatment plans.