A nurse is providing teaching about nifedipine for a client who is at 34 weeks of gestation and has gestational hypertension.
For which of the following adverse effects should the nurse instruct the client to notify the provider?

Choice A rationale

Terbutaline can cause tachycardia. A heart rate of 132/min is significantly higher than normal and could indicate severe cardiovascular effects.

Choice B rationale

While headaches can occur with terbutaline, they are generally not life-threatening and don't require immediate intervention compared to tachycardia.

Choice C rationale

Nasal congestion is a minor side effect and not a priority compared to a significantly elevated heart rate.

Choice D rationale

Tremors are common with terbutaline use, but they are usually not as concerning as a significantly elevated heart rate.

The correct answer is Choice A

Choice A rationale: Blood urea nitrogen (BUN) level of 25 mg/dL exceeds the normal range of 10 to 20 mg/dL and may indicate impaired renal function or dehydration. In pregnancy, elevated BUN is concerning because renal perfusion is typically increased, leading to lower BUN levels. A rise suggests possible renal compromise, which can affect fetal development and maternal health. It warrants provider notification to assess for underlying pathology such as preeclampsia or renal insufficiency.

Choice B rationale: Hemoglobin level of 10.2 mg/dL is slightly below the normal pregnancy range of 11 to 16 mg/dL, indicating mild anemia. However, in the context of pregnancy, especially with a known history of anemia, this value is not critically low. Iron supplementation and dietary adjustments are typically sufficient. It does not represent an acute complication unless accompanied by symptoms like fatigue, pallor, or tachycardia. Therefore, it does not require immediate provider notification.

Choice C rationale: Fasting blood glucose of 70 mg/dL is at the lower end of the normal range for pregnancy, which spans from 70 to 110 mg/dL. This value is physiologically acceptable and does not indicate hypoglycemia or gestational diabetes. During pregnancy, insulin sensitivity fluctuates, but a fasting glucose of 70 mg/dL is not pathologic. No intervention is needed unless symptomatic hypoglycemia occurs. Thus, this result is not indicative of a prenatal complication.

Choice D rationale: Hematocrit level of 32% is slightly below the normal pregnancy range of 33 to 47%, reflecting mild dilutional anemia due to plasma volume expansion. This is a common physiological adaptation in pregnancy and not necessarily pathologic. Unless accompanied by symptoms or a significant drop in hemoglobin, this value alone does not indicate a prenatal complication. Monitoring and nutritional support are appropriate, but urgent provider notification is not required.