A nurse is caring for a client whose pregnancy was complicated by polyhydramnios and is now 5 hours postpartum following a vaginal birth.
The nurse should recognize that this client is at risk for which of the following postpartum complications?

Based on the provided information, here is the completion of the sentence using the options:

The nurse assesses the Non-Stress Test (NST) and documents the results as Non-Reactive. The nurse contacts the provider and reports the NST results. The nurse anticipates an order for a Biophysical Profile.

A Non-Stress Test (NST) is used to monitor the fetal heart rate (FHR) and its response to fetal movements. A reactive NST indicates that there are accelerations in the FHR in response to fetal movements, which is a sign of fetal well-being. A non-reactive NST means that there are no accelerations in the FHR with fetal movements, suggesting that the fetus might not be as active or responding as expected.

In this case, the NST was non-reactive because there were no accelerations in the fetal heart rate. This can be a cause for concern, as it may indicate potential issues with the fetus that need further evaluation. Therefore, the nurse would document the NST as non-reactive and contact the provider for further assessment.

A Biophysical Profile (BPP) is often ordered after a non-reactive NST. The BPP is a more comprehensive test that includes an ultrasound to assess fetal movement, muscle tone, breathing movements, and amniotic fluid volume, in addition to another NST. This helps to provide a clearer picture of the fetus's well-being.

Choice A rationale:

A postpartum temperature of 100.4°F (38.0°C) or higher may indicate an infection. Infections can occur after delivery, particularly if there was a manual extraction of the placenta, as in this case. Close monitoring and further assessment are necessary to ensure the client does not develop sepsis or other complications.

Choice B rationale:

Fundal tone should be firm and well-contracted to prevent excessive bleeding postpartum. A boggy, midline fundus suggests that the uterus is not contracting effectively, increasing the risk for postpartum hemorrhage. This requires immediate attention and intervention to ensure adequate uterine tone and control bleeding.

Choice C rationale:

Lochia should be monitored for quantity, color, and the presence of clots. Heavy lochia with small clots indicates that the client may be experiencing postpartum hemorrhage, which is a significant concern. This can be related to uterine atony, retained placental fragments, or coagulopathies and warrants prompt evaluation and intervention.

Choice D rationale:

A respiratory rate of 17/min is within the normal adult range (12-20/min) and does not require follow-up. There are no signs of respiratory distress or abnormalities in this case, indicating that the client's respiratory status is stable and does not necessitate further evaluation.

Choice E rationale:

A white blood cell count of 12,000/mm³ is within the expected range for postpartum women, where normal values can be elevated due to physiological stress and inflammation from delivery. This level does not indicate infection or pathology and does not require follow-up in the context provided.

Choice F rationale:

Blood pressure of 144/92 mmHg is elevated and concerning, particularly in a postpartum client with a history of chronic hypertension and gestational diabetes. This could signal postpartum preeclampsia or other hypertensive disorders, requiring careful monitoring and management to prevent complications like seizures, stroke, or organ damage.