Which of the following findings should alert a nurse assessing a client who is 8 hr postpartum and multiparous?

Choice A rationale: A headache that lasts for 2 days and is not relieved by Tylenol is a concerning symptom in a pregnant client. This could be a sign of preeclampsia, a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the liver and kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal. Left untreated, preeclampsia can lead to serious — even fatal — complications for both mother and baby. Severe headaches are a common symptom of preeclampsia and should be reported to the healthcare provider immediately.

Choice B rationale: Blurred vision and dizziness are also symptoms of preeclampsia. These symptoms occur as a result of changes in the blood vessels in the brain due to high blood pressure. The brain relies on a healthy blood supply to function properly, and any disruption to this can lead to symptoms such as blurred vision and dizziness. These symptoms should be reported to the healthcare provider immediately as they may indicate a need for immediate treatment or monitoring.

Choice C rationale: While swelling of the feet is common in pregnancy due to fluid retention and increased blood flow, it is not typically a symptom that needs to be reported to the healthcare provider unless it is accompanied by other symptoms of preeclampsia or other complications. Swelling in the face and hands is more concerning than swelling in the feet.

Choice D rationale: 2+ pitting edema of the lower extremities is a sign of fluid overload in the body, which can be a symptom of preeclampsia. This should be reported to the healthcare provider as it may indicate a need for treatment or closer monitoring.

Choice E rationale: Deep tendon reflexes of 3+ and absent clonus are within normal limits for a pregnant client. Hyperreflexia (reflexes rated as 4+) and the presence of clonus could indicate neurological irritability associated with preeclampsia, but these findings are not present in this client.

Choice F rationale: Fetal heart tones of 150/min are within the normal range of 110-160 beats per minute. This is a reassuring sign and does not need to be reported to the healthcare provider.

Choice G rationale: A blood pressure of 180/99 mm Hg is significantly elevated and is a hallmark sign of preeclampsia. This should be reported to the healthcare provider immediately as it indicates severe preeclampsia, which requires immediate treatment to prevent complications such as eclampsia, placental abruption, and organ damage.

Choice A rationale

Regular physical activity is an important part of managing gestational diabetes. Most guidelines recommend at least 30 minutes of moderate-intensity exercise on most days of the week. Reducing the exercise schedule to only 3 days a week may not provide enough activity to help regulate blood glucose levels.
Choice B rationale
Limiting carbohydrates to 50% of caloric intake can be a part of a balanced diet for managing gestational diabetes. Carbohydrates have the biggest effect on blood sugar levels, so monitoring and regulating carbohydrate intake is key.
Choice C rationale
Glyburide is an oral medication that can be used to manage gestational diabetes when diet and exercise are not enough. It helps to lower blood glucose levels by stimulating the pancreas to release more insulin.
Choice D rationale
It is true that women who have had gestational diabetes are at an increased risk of developing type 2 diabetes later in life. Therefore, this statement does not indicate a need for further teaching.