A nurse is assisting in the care of a client at 36 weeks of gestation and who has preeclampsia with mild features and oligohydramnios.
Which of the following elements should the nurse recognize as the primary cause of oligohydramnios?

Choice A rationale

Monitoring blood pressure at 4 hour intervals is a standard nursing protocol for observing trends in gestational hypertension, which is defined as a systolic pressure ≥ 140 mm Hg or diastolic ≥ 90 mm Hg after 20 weeks. however, delayed assessment prevents the immediate identification of preeclampsia. Scientific management requires prompt data collection to determine if multi organ involvement is occurring, as waiting 4 hours could allow the condition to worsen without medical intervention or stabilization.

Choice B rationale

Proteinuria is a hallmark diagnostic sign of preeclampsia, reflecting glomerular capillary endotheliosis and increased permeability of the basement membrane in the kidneys. Normal urine protein is typically < 30 mg/dL on a dipstick or < 300 mg in a 24 hour collection. Identifying protein in the urine of a client with a blood pressure of 150/98 mm Hg is the priority to distinguish simple gestational hypertension from potentially life threatening preeclampsia at 24 weeks.

Choice C rationale

Assessing dietary habits, particularly sodium and protein intake, provides context for long term nutritional status and fluid retention. While high sodium might contribute to edema, it is not the primary cause of hypertension in pregnancy, which is rooted in vasospasm and endothelial dysfunction. This action is supportive and educational rather than diagnostic or urgent in the acute setting where a high blood pressure reading has already been documented and requires immediate pathological screening.

Choice D rationale

Measuring weight is necessary to detect rapid gains, often exceeding 2 kg or 4.4 lb per week, which suggests significant fluid shifts and generalized edema. Edema results from decreased plasma oncotic pressure and capillary leaking associated with systemic vascular damage. While weighing the client provides data on fluid status, it is less specific than a urine protein test for diagnosing preeclampsia and determining the severity of the hypertensive disorder in the current clinical moment.

Choice A rationale

Restricting carbohydrate intake to 30 percent is generally considered too restrictive for a pregnant client. Standard nutritional guidelines for gestational diabetes usually recommend that carbohydrates comprise approximately 40 to 50 percent of total daily caloric intake to ensure adequate energy for fetal development. Extreme restriction can lead to ketonemia, which is potentially harmful to the developing fetal neurological system. Complex carbohydrates are preferred over simple sugars to prevent rapid glycemic spikes and maintain steady energy levels.

Choice B rationale

High fiber foods are essential in the management of gestational diabetes because they slow the absorption of glucose in the intestinal tract. Soluble fiber creates a viscous gel that delays gastric emptying and reduces the postprandial glycemic response. This helps in maintaining blood glucose levels within the target range of 60 to 95 mg/dL preprandial and less than 140 mg/dL one hour postprandial. Fiber also assists in maintaining bowel regularity and promotes a feeling of fullness.

Choice C rationale

Monitoring blood glucose levels only once per day is insufficient for a client with gestational diabetes. Effective management typically requires testing at least four times daily, including a fasting glucose level upon waking and postprandial levels after each major meal. Frequent monitoring allows the healthcare team to adjust dietary or pharmacological interventions accurately. Consistent tracking is vital to prevent complications such as fetal macrosomia, neonatal hypoglycemia, and maternal preeclampsia associated with poorly controlled hyperglycemia.

Choice D rationale

Moderate exercise for 30 minutes a day, five days a week, is a recommended strategy to improve insulin sensitivity. Physical activity increases the uptake of glucose by skeletal muscles through insulin-independent mechanisms, such as the translocation of GLUT4 transporters. This helps lower blood glucose levels naturally. Safe exercises for pregnant women include walking or swimming, which improve cardiovascular health without causing excessive physical stress or fetal distress, provided there are no contraindications like ruptured membranes.

Choice E rationale

If lifestyle modifications such as medical nutrition therapy and regular physical activity fail to achieve glycemic targets, pharmacological intervention becomes necessary. Insulin is often the gold standard because it does not cross the placenta, though oral hypoglycemic agents like glyburide or metformin may be considered in specific cases. The goal is to prevent maternal hyperglycemia, which triggers fetal hyperinsulinemia. Consistent blood glucose control is critical to reduce the risks of birth trauma and respiratory distress syndrome.