A nurse is reviewing the electronic health record of a client who has severe preeclampsia and is being induced with oxytocin.

Which of the following findings should the nurse report to the provider immediately?

The correct answer is choice A and C. A client with HELLP syndrome is at risk for bleeding, liver damage, and fluid overload or transfusion reaction.Therefore, the nurse should monitor vital signs and urine output to assess for signs of shock, hemorrhage, or renal failure.The nurse should also check for signs of fluid overload or transfusion reaction such as dyspnea, crackles, edema, fever, chills, or rash.

Choice B is wrong because corticosteroids are not indicated for clients with HELLP syndrome unless they have severe thrombocytopenia or need to delay delivery for fetal lung maturity.Corticosteroids may worsen the liver function and increase the risk of infection.

Choice D is wrong because encouraging oral intake of fluids and electrolytes may exacerbate fluid overload and hypertension in clients with HELLP syndrome.Fluid restriction and diuretics may be prescribed to reduce the risk of pulmonary edema and cerebral edema.

Choice E is wrong because maintaining bed rest and a quiet environment may not be sufficient to prevent the progression of HELLP syndrome.The definitive treatment for HELLP syndrome is delivery of the fetus and placenta as soon as possible.Bed rest and a quiet environment may help reduce blood pressure and stress, but they are not the main interventions for this condition.

Oligohydramnios on ultrasound.Oligohydramnios is a condition where the amniotic fluid volume is less than expected for gestational age.It can be a sign of fetal compromise due to various causes, such as renal abnormalities, placental insufficiency, premature rupture of membranes, or chromosomal anomalies.Oligohydramnios can lead to complications such as fetal deformities, preterm birth, infection, or stillbirth.

Choice A is wrong because a fetal heart rate of 140 beats/min is within the normal range for most of pregnancy.

Choice B is wrong because fetal movement of 10 times in an hour is also within the normal range and indicates fetal well-being.

Choice D is wrong because a reactive nonstress test is a reassuring sign that the fetus is not hypoxic or stressed.

Normal ranges:

• Amniotic fluid index (AFI): 5-25 cm

• Fetal heart rate: 110-160 beats/min

• Fetal movement: at least 10 movements in 2 hours

• Nonstress test: at least two accelerations of fetal heart rate of 15 beats/min for 15 seconds or more in 20 minutes