A nurse is caring for several clients. The nurse should recognize that it is safe to administer tocolytic therapy to which of the following clients?

Choice A reason: This client should be seen first, as she has the most urgent and acute problem that requires immediate assessment and intervention. Severe pain after a cesarean birth can indicate infection, hemorrhage, or wound dehiscence, which are serious complications that can affect the client's recovery and well-being. The nurse should evaluate the client's pain level, location, and characteristics, and administer analgesics as prescribed. The nurse should also inspect the incision site, monitor the vital signs and lochia, and provide comfort measures.

Choice B reason: This client should be seen second, as she has a chronic and stable problem that requires ongoing monitoring and management. Preeclampsia is a hypertensive disorder of pregnancy that can cause complications, such as eclampsia, HELLP syndrome, or placental abruption. However, this client has a mild elevation of blood pressure that does not indicate severe preeclampsia or imminent eclampsia. The nurse should check the client's urine protein, reflexes, and edema, and report any signs of worsening condition to the provider.

Choice C reason: This client should be seen third, as she has a normal and expected outcome that requires routine education and discharge planning. A vaginal delivery without complications does not pose any significant risk or concern for the client or the newborn. The nurse should review the discharge instructions, such as follow-up appointments, self-care, breastfeeding, and warning signs, and answer any questions that the client may have.

Choice D reason: This client should be seen last, as she has a common and benign finding that requires reassurance and documentation. A scant amount of lochia after a vaginal birth is normal and expected, as it reflects the healing and involution of the uterus. The nurse should assess the color, odor, and consistency of the lochia, and provide perineal care and hygiene education to the client.

Choice A reason: Preeclampsia is not the correct answer, as it is a hypertensive disorder of pregnancy that causes high blood pressure, proteinuria, and edema. Preeclampsia can be a risk factor for abruptio placentae, which is a premature separation of the placenta from the uterine wall, but it is not a complication of it. Preeclampsia does not cause petechiae or bleeding around the IV access site, but rather headaches, blurred vision, or epigastric pain.

Choice B reason: Anaphylactoid syndrome of pregnancy is not the correct answer, as it is a rare and fatal condition that occurs when the amniotic fluid enters the maternal circulation and causes an allergic reaction. Anaphylactoid syndrome of pregnancy can occur as a complication of abruptio placentae, but it is not indicated by the petechiae or bleeding around the IV access site. Anaphylactoid syndrome of pregnancy would cause respiratory distress, hypotension, or cardiac arrest.

Choice C reason: Puerperal infection is not the correct answer, as it is a bacterial infection of the reproductive tract that occurs after childbirth. Puerperal infection can occur as a complication of abruptio placentae, but it is not indicated by the petechiae or bleeding around the IV access site. Puerperal infection would cause fever, foul-smelling lochia, or pelvic pain.

Choice D reason: Disseminated intravascular coagulation is the correct answer, as it is a coagulation disorder that causes widespread clotting and bleeding in the body. Disseminated intravascular coagulation can occur as a complication of abruptio placentae, and it is indicated by the petechiae and bleeding around the IV access site. Disseminated intravascular coagulation would also cause a low platelet count, a prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), and a low fibrinogen level.