The home care nurse visits a pregnant client who has a diagnosis of mild preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the primary health care provider (PHCP)?
Blood pressure reading is at the prenatal baseline.
Dependent edema has resolved.
Urinary output has increased.
The client complains of a headache and blurred vision.
The Correct Answer is D
A. Blood pressure reading is at the prenatal baseline. If blood pressure remains stable, it does not indicate worsening preeclampsia.
B. Dependent edema has resolved. A decrease in edema suggests an improvement, not worsening, of preeclampsia.
C. Urinary output has increased. Decreased urinary output is concerning in preeclampsia, while increased output suggests better kidney function.
D. The client complains of a headache and blurred vision. These are signs of severe preeclampsia, indicating possible cerebral edema or hypertensive crisis, which requires immediate medical attention.
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Correct Answer is D
Explanation
A. "I will need to eat 600 more calories per day because I am pregnant." Pregnant clients with diabetes require careful calorie management. The recommended increase is about 300 kcal/day, not 600, to support fetal growth while maintaining glycemic control.
B. "I will plan my diet based on the results of urine glucose testing." Urine glucose testing is not a reliable indicator of blood glucose control because it does not reflect real-time fluctuations. Clients should base dietary adjustments on blood glucose monitoring.
C. "I can continue with the same diet as before pregnancy as long as it is well balanced." Pregnancy alters insulin needs, requiring dietary modifications to maintain blood glucose control. Carbohydrate intake must be carefully regulated to prevent hyperglycemia.
D. "Diet and insulin needs change during pregnancy." Hormonal changes in pregnancy increase insulin resistance, necessitating adjustments in diet and insulin therapy to maintain optimal blood glucose levels.
Correct Answer is B
Explanation
A. To stimulate uterine contractions: Terbutaline is a tocolytic (a medication that relaxes the uterus), not a uterotonic. It is not used to stimulate contractions.
B. To improve placental blood flow: Terbutaline relaxes uterine muscles, decreasing contraction frequency and intensity, thereby improving placental blood flow. It is often used in intrauterine resuscitation when there is uteroplacental insufficiency and fetal distress due to excessive contractions (tachysystole).
C. To decrease fetal heart rate variability: Terbutaline does not directly affect fetal heart rate variability. It is used to reduce uterine contractions, which can secondarily improve fetal oxygenation.
D. To prevent preterm labor: While terbutaline can be used to delay preterm labor, in this context, it is being used for intrauterine resuscitation, not for preventing labor.
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