A nurse is caring for a client who had a myocardial infarction and is receiving unfractionated heparin. Which of the following laboratory tests should the nurse monitor to assess the effectiveness of the medication?

Rationale:
A. Amniocentesis is not indicated in this situation. The client’s findings (hypertension, thrombocytopenia, elevated liver enzymes, proteinuria, hyperuricemia, and symptoms such as headache and RUQ pain) are consistent with severe preeclampsia with possible HELLP syndrome. Management focuses on maternal stabilization and possible delivery, not fetal lung maturity testing via amniocentesis.

B. Preeclampsia and HELLP syndrome are not infectious conditions. Standard precautions are appropriate, but contact precautions are unnecessary.

C. Internal fetal monitoring (e.g., fetal scalp electrode) requires ruptured membranes and sufficient cervical dilation, and it is typically avoided unless necessary. In a client with severe preeclampsia, the priority is maternal stabilization and noninvasive fetal monitoring unless labor is progressing.

D. The client has worsening hypertension (156/96 mm Hg) consistent with severe preeclampsia. Frequent blood pressure monitoring is essential to assess progression and guide antihypertensive therapy.

E. The client has severe preeclampsia with headache and hyperreflexia (3+ DTRs), indicating increased seizure risk. A quiet, low-stimulation environment helps reduce the risk of seizures.

F. Bed rest (typically left lateral positioning) helps improve uteroplacental perfusion and reduce blood pressure in clients with preeclampsia. Although strict bed rest is less commonly prescribed long-term, in acute severe cases hospitalization with limited activity is appropriate.

G. The client already has hyperreflexia (3+ DTRs), a warning sign of worsening CNS irritability and impending eclampsia. Ongoing monitoring is essential to detect progression.

H. The client has elevated creatinine and BUN, indicating possible renal involvement. Monitoring urine output helps assess kidney perfusion and detect worsening preeclampsia or renal impairment.

A. Contacting a provider to admit the client for inpatient care is not appropriate because there is no indication of acute complications or unstable blood glucose requiring hospitalization. Type 2 diabetes management goals are typically achieved in the outpatient setting unless there is an emergency such as diabetic ketoacidosis or severe hyperglycemia.

B. Contacting a nurse navigator for a referral to a diabetes support group may be helpful for emotional support and education, but it does not directly address structured goal-setting, ongoing monitoring, and coordinated long-term disease management needed for achieving clinical outcomes in type 2 diabetes.

C. Contacting a case manager to enroll the client in a disease management program is the correct action. Disease management programs provide coordinated, evidence-based care that includes monitoring, education, medication adherence support, and follow-up. This approach directly helps clients with chronic conditions like type 2 diabetes meet individualized goals such as glycemic control, lifestyle modification, and complication prevention.

D. Contacting a social worker for financial assistance with medications may be beneficial if cost is a barrier to care; however, it addresses only one aspect of care and does not provide comprehensive support for achieving clinical outcomes and long-term diabetes management goals.