A pregnant client has a history of chronic hypertensive disease.
Which medication would the nurse not expect to be prescribed for this client?

Choice A rationale

Increased pain with urination, known as dysuria, is a primary symptom often associated with a urinary tract infection (UTI), not specifically polyhydramnios. While an enlarged uterus could theoretically cause compression and urinary symptoms, dysuria is a localized inflammatory response from the lower urinary tract, caused by microbial pathogens ascending the urethra, leading to mucosal irritation and pain during micturition.

Choice B rationale

A tense (firm) uterus is a key physical sign of polyhydramnios, reflecting the excessive accumulation of amniotic fluid. This fluid volume stretches the myometrium, leading to palpable firmness or rigidity upon abdominal assessment. Normal amniotic fluid volume in the third trimester is approximately 800-1000 mL, while polyhydramnios involves a volume typically exceeding 2000 mL or an Amniotic Fluid Index (AFI) greater than 24-25 cm.

Choice C rationale

Difficulty auscultating fetal heart sounds occurs because the excessive amniotic fluid acts as a buffer or sound barrier, significantly dampening the transmission of the fetal heart sounds to the mother's abdomen. The fluid-filled space between the fetal chest wall and the uterine wall scatters the sound waves, making the detection of the fetal heart rate via external Doppler or stethoscope challenging.

Choice D rationale

Sudden weight loss is not characteristic of polyhydramnios; in fact, the opposite is expected. The massive volume increase from the excess amniotic fluid, coupled with the enlarged fetus and placenta, typically results in a rapid or excessive maternal weight gain, far exceeding the normal gestational weight gain rate for the specific trimester.

Choice E rationale

Maternal shortness of breath (dyspnea) is a common symptom of severe polyhydramnios. The dramatically enlarged uterus pushes the diaphragm cephalad (upward), mechanically restricting the downward excursion of the diaphragm during inspiration, thereby reducing the functional lung capacity and making breathing more difficult, especially when the client is supine.

Choice F rationale

A uterus larger than expected for gestational week (LGA), also termed fundal height greater than dates, is a primary clinical finding of polyhydramnios. The excessive fluid distends the uterus significantly more than a normal pregnancy would, causing the measured fundal height to exceed the expected measurement (typically ≥ 3 cm difference) based on the last menstrual period and standard growth charts.

Choice A rationale

Labetalol is a combined α and β-adrenergic blocker and is a preferred first-line agent for managing chronic or gestational hypertension in pregnancy. It acts by reducing systemic vascular resistance and mildly decreasing heart rate, effectively lowering blood pressure while minimizing risks to the developing fetus due to its established safety profile.

Choice B rationale

Digoxin is a cardiac glycoside primarily used to treat heart failure and control the ventricular rate in atrial fibrillation. While not a primary antihypertensive, it may be used in pregnant clients with pre-existing heart failure, which can complicate chronic hypertension, making its prescription possible in this client population.

Choice C rationale

Warfarin, an oral anticoagulant, is a teratogen classified as Pregnancy Category D, as it readily crosses the placenta and is associated with the Warfarin embryopathy (nasal hypoplasia, stippled epiphyses) in the first trimester, and fetal hemorrhage, making it generally contraindicated in pregnancy. Low molecular weight heparin is preferred.

Choice D rationale

Nitroglycerin, a potent vasodilator, is a medication that can be used intravenously to quickly manage severe, acute hypertensive crises in pregnant clients, although it's not a medication for chronic daily use. Its rapid action and control of blood pressure make it a potential, albeit specialized, option in obstetric emergencies.