A nurse is reinforcing teaching with a client who smokes one pack of cigarettes per day.
The nurse should instruct the client that her newborn is at increased risk for which of the following clinical manifestations?

Choice A:
It is inaccurate to state that urinary frequency will continue throughout pregnancy in most cases. While it is a common symptom, it typically resolves by the end of the first trimester.
Suggesting that poor bladder tone is the cause of ongoing urinary frequency is not supported by evidence. This response may unnecessarily alarm a client who is already experiencing discomfort.

Choice B:
It is not recommended to advise a pregnant woman to decrease her fluid intake, especially during the first trimester when adequate hydration is crucial.
Restricting fluids can lead to dehydration, which can have negative consequences for both the mother and the fetus. While reducing fluid intake before bedtime might lessen nighttime urination, it does not address the underlying cause of urinary frequency.

Choice C:
While it is true that the duration of urinary frequency can vary among individuals, providing such an uncertain response may not be helpful to the client.
It is important to offer information that is both accurate and reassuring.

Choice D:
This response accurately conveys that urinary frequency is a common early pregnancy symptom that typically resolves by the end of the first trimester.
It also acknowledges that the symptom may return later in pregnancy, which helps to prepare the client for potential discomfort.
This response provides accurate information in a reassuring manner, making it the most appropriate choice.

Rationale for Choice A: Visual disturbances
Preeclampsia: Visual disturbances, such as blurred vision or seeing spots, can be a sign of preeclampsia, a serious pregnancy complication characterized by high blood pressure and protein in the urine. It typically develops after 20 weeks of gestation and can progress rapidly.
Potential complications: If left untreated, preeclampsia can lead to seizures (eclampsia), stroke, liver and kidney failure, premature birth, and even death of the mother or baby.
Prompt reporting: Early recognition and management of preeclampsia are crucial for preventing adverse outcomes. Therefore, visual disturbances should be reported to the provider immediately to initiate further assessment and potential interventions.

Rationale for Choice B: Fetal heart rate
No indication for reporting: While monitoring fetal heart rate is essential during pregnancy, the promptness of reporting it to the provider depends on specific concerns. In this case, the fetal heart tones are documented as 1, suggesting a normal rate and rhythm. There's no immediate indication for reporting it as a concerning finding.

Rationale for Choice C: Blood pressure
Hypertension: High blood pressure is a key feature of preeclampsia. Although blood pressure readings are not provided in the scenario, the nurse should measure and report them to the provider, as hypertension is a critical finding that could necessitate further evaluation and treatment.

Rationale for Choice D: Deep tendon reflexes
Hyperreflexia: The client's deep tendon reflexes are 3+, which is considered hyperreflexia. Hyperreflexia can be a neurological sign of preeclampsia, indicating increased excitability of the nervous system. It's important to report this finding to the provider for further assessment and monitoring.