A 28‑year‑old primiparous client delivered vaginally 24 hours ago. She now reports a persistent headache, blurred vision, and right upper quadrant pain. Her blood pressure is 160/100 mmHg. The nurse suspects worsening preeclampsia and prepares to perform focused assessments. Which assessments should the nurse prioritize to evaluate for complications of preeclampsia? (Select all that apply.)

Choice A rationale

An LDH level of 525 U/L is elevated (normal range is 140-280 U/L), which can indicate cell damage, particularly in the liver. However, this finding alone does not necessitate an immediate cesarean section. Delivery is the definitive cure for preeclampsia, but it is not automatically triggered by a single elevated lab value without other signs of maternal or fetal compromise. A cesarean section is a major surgical procedure.

Choice B rationale

An uric acid level of 5.8 mg/dL is within or near the normal range for women (2.4-6.0 mg/dL), and therefore, no medication is needed to lower it. Elevated uric acid is a common finding in preeclampsia due to decreased renal clearance, but this specific level is not considered pathologically high enough to require therapeutic intervention. The focus is on the overall clinical picture, not a single normal lab value.

Choice C rationale

An elevated lactate dehydrogenase (LDH) level, along with other signs and symptoms, is a marker of cell damage and hemolysis, often associated with HELLP syndrome. This syndrome is a severe form of preeclampsia involving Hemolysis, Elevated Liver enzymes, and Low Platelets. Monitoring for signs of liver dysfunction, such as right upper quadrant pain or jaundice, is essential to detect this serious complication.

Choice D rationale

Restricting fluid intake is not an appropriate intervention to decrease uric acid levels in preeclampsia. In fact, severe fluid restriction can be harmful and may worsen maternal hypovolemia, which is already a concern in preeclampsia due to capillary leakage. Uric acid is typically managed by addressing the underlying preeclampsia and promoting diuresis, not restricting fluids.

Choice A rationale

Expulsion of the products of conception is a form of spontaneous abortion. The most immediate risk to the client is postpartum hemorrhage. The nurse must assess for uterine bleeding and firmness of the fundus, which indicates the uterus is contracting and clamping down blood vessels. A soft or boggy uterus is a sign of uterine atony and increases the risk of hemorrhage.

Choice B rationale

Providing emotional support is a crucial nursing intervention, but it is not the most important in the immediate aftermath of a spontaneous abortion. The client's physical stability and safety are the highest priority. Once the nurse has addressed the immediate physiological needs and ensured the client is stable, then emotional support can be provided.

Choice C rationale

Notifying the healthcare provider is an important step, but it follows the initial assessment of the client's physical status. The nurse must first gather essential information regarding the client's bleeding and fundal tone to provide a complete report. This ensures that the provider can make informed decisions about further interventions.

Choice D rationale

Removing the expelled material is part of providing hygienic care and comfort to the client. While important, it is not the most critical intervention. The immediate life-threatening risk is postpartum hemorrhage, which is addressed by assessing uterine bleeding and fundal firmness. Physical stability takes precedence over environmental cleanup.