A nurse is caring for a client who arrives at the labor and delivery unit.
Which of the following findings should the nurse identify as potential manifestations of a placental abruption? (Select all that apply.)

Choice A rationale

This statement is scientifically incorrect for overt hyperthyroidism. In overt hyperthyroidism, the thyroid gland produces an excess of thyroid hormones, specifically thyroxine (T4) and triiodothyronine (T3). This excess causes a negative feedback loop on the pituitary gland, resulting in a significantly decreased or suppressed level of Thyroid Stimulating Hormone (TSH). Therefore, the correct laboratory profile would show a low TSH and an increased serum level of T4, which is the opposite of the statement provided.

Choice B rationale

Feeling like the heart is racing, known as palpitations or tachycardia, is a hallmark symptom of overt hyperthyroidism. Elevated levels of thyroid hormones increase the sensitivity of beta-adrenergic receptors in the heart. This leads to an increased heart rate and force of contraction. In pregnancy, this can be particularly concerning as the baseline heart rate already increases slightly. Tachycardia reflects the hypermetabolic state and the direct stimulatory effect of T4 on the cardiac conduction system.

Choice C rationale

Overt hyperthyroidism can lead to weight loss or, in the context of pregnancy, an inability to gain the expected amount of weight despite an increased appetite. Thyroid hormones regulate the basal metabolic rate; an excess of these hormones accelerates metabolism, leading to increased caloric expenditure. Significant weight loss during pregnancy is a concerning sign that can affect both maternal health and fetal development, necessitating close monitoring of nutritional intake and thyroid hormone stabilization.

Choice D rationale

Increased sweating and heat intolerance are common manifestations of hyperthyroidism. Because thyroid hormones stimulate thermogenesis, or the production of heat within the body's tissues, the client's internal temperature regulation is shifted. This results in diaphoresis as the body attempts to dissipate the excess heat generated by the accelerated metabolic processes. Clients often report feeling uncomfortably warm even in cool environments, which is a direct result of the systemic effects of thyroxine.

Choice E rationale

Trouble sleeping, or insomnia, is frequently associated with overt hyperthyroidism. The excess of thyroid hormones acts as a central nervous system stimulant, leading to symptoms such as anxiety, restlessness, and irritability. This heightened state of physiological arousal makes it difficult for the client to fall asleep or maintain restful sleep. This lack of rest can exacerbate other symptoms, such as fatigue and palpitations, further complicating the clinical picture of the pregnant client.

Choice A rationale

While a healthy diet is generally recommended during pregnancy, restricting high-sugar foods is not a specific primary intervention for managing gestational hypertension unless the client also has concurrent gestational diabetes. The focus in hypertension is on monitoring blood pressure, detecting protein in the urine, and observing for signs of preeclampsia. While nutrition is important for overall health, sugar intake does not have a direct, evidence-based causal link to the immediate stabilization of hypertensive blood pressure readings.

Choice B rationale

Encouraging a client with gestational hypertension to begin an evening walking regimen is inappropriate and potentially harmful. In the management of hypertensive disorders of pregnancy, providers typically recommend activity restriction or modified bed rest rather than starting new exercise routines. Physical exertion can further elevate blood pressure and increase the risk of transitioning from gestational hypertension to preeclampsia or eclampsia. Rest is prioritized to maximize uteroplacental perfusion and minimize systemic stress on the maternal cardiovascular system.

Choice C rationale

Monitoring weight gain is a critical health promotion recommendation for clients with gestational hypertension. Rapid weight gain, often defined as more than 2 pounds or 0.9 kg in a single week, can be an early clinical sign of fluid retention and the development of edema. This often precedes more severe manifestations of preeclampsia. Regular weighing allows the client and healthcare provider to track fluid status and intervene early if sudden shifts suggest worsening systemic vascular permeability.

Choice D rationale

Limiting caffeine to 400 mg per day is incorrect because the standard recommendation for pregnant individuals is to limit caffeine to less than 200 mg per day. Caffeine is a stimulant that can cause vasoconstriction and transient increases in blood pressure, which is counterproductive in a client already experiencing hypertension. High intake may also affect fetal growth. Therefore, recommending a 400 mg limit provides a false sense of safety for a dose that is actually too high.

Choice E rationale

Taking a magnesium supplement for headaches is an unsafe recommendation. Headaches in a client with gestational hypertension are "red flag" symptoms that may indicate the onset of preeclampsia or worsening neurological irritability. These symptoms require immediate medical evaluation rather than self-medication. Furthermore, while magnesium sulfate is used in the hospital to prevent seizures in preeclampsia, oral magnesium supplements are not a recognized or effective treatment for hypertensive headaches during pregnancy and could delay necessary care.

Choice F rationale

Attending all prenatal visits is essential for the safe management of gestational hypertension. Frequent monitoring allows healthcare providers to assess blood pressure trends, perform urinalysis for protein, and monitor fetal well-being through non-stress tests or biophysical profiles. Because gestational hypertension can progress rapidly to preeclampsia, consistent surveillance is the most effective way to identify complications early, manage symptoms, and determine the optimal timing for delivery to ensure the safety of both mother and infant.