In labor, GPTAL is used to assess the client's obstetric history. What does the 'P' in GPTAL stand for?

A. Provide a dark, quiet environment. Clients with severe gestational hypertension are at risk for seizures (eclampsia). A dark, quiet environment helps reduce stimuli that can trigger seizures.

B. Administer magnesium sulfate IV. Magnesium sulfate is the drug of choice to prevent seizures in clients with severe gestational hypertension or preeclampsia.

C. Ensure that calcium gluconate is readily available. Calcium gluconate is the antidote for magnesium sulfate toxicity and should always be available when administering magnesium sulfate.

D. Assess respiratory status every 4 hr. Respiratory status should be assessed more frequently (at least every hour) when administering magnesium sulfate, as respiratory depression is a sign of toxicity.

E. Evaluate neurologic status every 8 hr. Neurologic status should be evaluated at least every 1-2 hours, as changes (e.g., confusion, headaches, hyperreflexia) can indicate worsening preeclampsia or impending seizure activity.

A. A client who is at 28 weeks of gestation and receiving terbutaline reports fine tremors: Fine tremors are a common expected side effect of terbutaline, which is a beta-adrenergic agonist used to stop preterm labor. It is not an emergency but should be monitored.

B. A client who has a diagnosis of preeclampsia has 2+ proteinuria and 2+ patellar reflexes: Proteinuria and 2+ reflexes are consistent with mild preeclampsia and do not necessarily indicate worsening or severe disease. However, monitoring is required to detect progression.

C. A client who has a diagnosis of preeclampsia reports epigastric pain and unresolved headache: Epigastric pain and a persistent headache suggest impending eclampsia or hepatic involvement (HELLP syndrome) and require immediate medical intervention to prevent seizures, stroke, or organ failure.

D. A tearful client who is at 32 weeks of gestation and is experiencing irregular, frequent contractions: Irregular contractions at 32 weeks may indicate Braxton Hicks contractions or preterm labor, but they do not necessarily require immediate provider notification unless they become regular and progressive.