A nurse is caring for a client who has preeclampsia and is experiencing a postpartum hemorrhage. The nurse should expect the provider to prescribe which of the following medications?

A. Return in two weeks for a follow up MRI: Clients with an implantable cardioverter/defibrillator (ICD) should generally avoid MRI unless the device is specifically labeled MRI-compatible. Magnetic fields can interfere with the ICD’s function and pose serious risks.
B. Wear loose-fitting clothing: Loose clothing prevents friction or pressure over the ICD insertion site, which promotes comfort and reduces the risk of irritation or infection during the healing period after implantation.
C. Expect to have a rapid pulse rate for the first few weeks: A rapid pulse is not an expected finding after ICD placement. If it occurs, it could indicate arrhythmia or improper device function, and should be evaluated promptly.
D. Resume tub baths and swimming after 24 hr: Immersing the incision site in water within 24 hours increases the risk of infection. Clients are typically advised to avoid submerging the area until the incision has fully healed, usually after 2-4 weeks.

Rationale for Correct Choices:

• DTR 2+ bilaterally: The deep tendon reflexes improved from 1+ earlier (indicating possible magnesium toxicity) to 2+, which falls within the normal range of 1+ to 3+. This suggests better neuromuscular function and reduced magnesium side effects.
• Urine output 40 mL/hr: Increased from a low 20 mL/hr at 1400 to 40 mL/hr at 1800, above the normal minimum urine output (>30 mL/hr). This reflects improved renal perfusion and fluid balance, crucial for preventing complications in preeclampsia.
• Oxygen saturation 95% on 2 L nasal cannula: Oxygen saturation stabilized at 95%, which is the lower limit of normal (95–100%). Previously it was 92% on room air, indicating improved oxygenation with supplemental oxygen support.
• Respiratory rate 18/min: Improved from shallow respirations at 14/min to 18/min, which falls within the normal adult range (12–20/min). This indicates better respiratory effort and gas exchange.
• Blood pressure 146/96 mm Hg: Decreased from a hypertensive crisis level of 170/112 mm Hg at 1400 to 146/96 mm Hg, showing effective blood pressure management though still above the ideal (<120/80 mm Hg). This reduction lowers the risk of severe complications.

Rationale for Incorrect Choices:

• Temperature 38.3° C (101° F): Elevated above the normal range (36.5–37.5° C), this fever suggests possible infection or inflammatory response and does not represent clinical improvement. It requires further evaluation and treatment.
• Heart rate 58/min: Decreased from 80/min to 58/min, falling below the normal range of 60–100/min. This bradycardia may be a sign of magnesium toxicity or cardiovascular suppression and requires close monitoring.