A nurse is caring for a newborn who is 30 minutes old in the newborn nursery.

Exhibits

The condition that poses the greatest risk to the newborn is

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due to

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.

Rationale for Correct Condition

Preeclampsia is characterized by hypertension (≥140/90 mm Hg) and proteinuria (≥300 mg/24 hr) or signs of systemic involvement such as headache and edema. The client’s elevated BP, significant proteinuria, headache, hyperreflexia, and pitting edema strongly indicate preeclampsia. The absence of seizures rules out eclampsia, and the gestational age excludes chronic hypertension with superimposed preeclampsia.

Rationale for Correct Actions

Magnesium sulfate prevents seizures by stabilizing neuronal excitability and reducing cerebral vasospasm. It also lowers BP by promoting vascular relaxation. External fetal monitoring detects fetal distress from utero-placental insufficiency caused by preeclampsia-related hypertension and endothelial dysfunction.

Rationale for Correct Parameters

Blood pressure reflects disease progression and response to antihypertensives. Severe hypertension increases the risk of cerebral hemorrhage and placental abruption. Deep tendon reflexes indicate neurological impairment. Hyperreflexia signals worsening preeclampsia, while absent reflexes may indicate magnesium toxicity.

Rationale for Incorrect Conditions

Gestational hypertension lacks proteinuria and systemic symptoms. Chronic hypertension with superimposed preeclampsia requires a pre-existing hypertensive diagnosis. Eclampsia involves seizures, which the client has not reported.

Rationale for Incorrect Actions

Ampicillin is not indicated without infection. Rh immune globulin is unnecessary without Rh incompatibility. Anticoagulants are not first-line for preeclampsia.

Rationale for Incorrect Parameters

Temperature is not directly related to preeclampsia. Petechiae are signs of coagulopathy, not primary indicators. Pruritus is irrelevant unless liver dysfunction is suspected.

Take-Home Points

• Preeclampsia involves multisystem dysfunction with endothelial damage.
• Magnesium sulfate prevents seizures but must be monitored for toxicity.
• Differentiation from gestational hypertension is crucial for management.
• Fetal monitoring is key to detecting early signs of compromise.

Choice A rationale

Accumulation of flatulence can cause abdominal discomfort after a cesarean birth, but it does not directly stimulate uterine contractions leading to afterpains. Afterpains are specifically related to the involution of the uterus, not gastrointestinal motility.

Choice B rationale

Breastfeeding stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is a powerful uterotonic hormone that causes the uterus to contract to its pre-pregnant size. These contractions are experienced as afterpains, especially in multiparous women whose uterine muscles may have less tone.

Choice C rationale

While some medications administered after birth can have side effects, severe cramps or afterpains are primarily a physiological response to uterine involution and the hormonal changes associated with breastfeeding, rather than a direct adverse effect of medication.

Choice D rationale

Healing of the abdominal incision after a C-section causes incisional pain, which is distinct from the cramping sensation of afterpains. Afterpains are specifically due to uterine contractions, not the healing process of the abdominal wall.