A 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 physician?

1. A

   Urinary output has increased

2. B

   Dependent edema has resolved

3. C

   Blood pressure reading is at the prenatal baseline

4. D

   The client complains of a headache and blurred Vision

Appeared in: DHS 2018 shift 1st

Explanation

• Complaints of headache and blurred vision are classic signs of central nervous system (CNS) involvement in preeclampsia.
• These symptoms are caused by cerebral vasospasm and edema, indicating that the condition is progressing from mild to severe.
• The development of these 'ominous signs' suggests an increased risk of eclampsia (seizures), a life-threatening complication.
• This finding requires immediate notification of the physician for further evaluation and potential intervention, such as hospitalization and administration of magnesium sulfate.

Why Other Options Were Wrong

• Option A: Increased urinary output is a positive sign, indicating adequate renal perfusion and function.
• Option B: Resolution of dependent edema is a sign of improvement, as fluid is shifting back into the intravascular space.
• Option C: A blood pressure reading at the prenatal baseline indicates that the hypertension is controlled or resolving.

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Clinical Relevance

• Nursing practice connection: Use the key finding related to Recognition of signs indicating the worsening of preeclampsia to guide bedside assessment, documentation, and the next nursing action.
• A home care nurse's ability to recognize the signs of worsening preeclampsia is critical for preventing maternal and fetal morbidity and mortality.
• Prompt identification and reporting of severe features like headache and visual disturbances allow for timely intervention, which may include hospitalization, administration of magnesium sulfate for seizure prophylaxis, and antihypertensive therapy.
• Patient education is a key nursing role. The nurse must teach the client and her family to report symptoms like severe headache, visual changes, or epigastric pain immediately.

How to Approach the Question

• First, identify the core clinical question: which finding signals a deterioration in a patient with mild preeclampsia?
• Recall the pathophysiology of preeclampsia. It's a progressive disorder where mild disease can become severe. The key is to differentiate signs of improvement from signs of worsening.
• Evaluate each option. Ask yourself, 'Is this a good sign or a bad sign in the context of preeclampsia?'
• Increased urine output (Option A), resolved edema (Option B), and baseline BP (Option C) are all positive developments, indicating the condition is improving or stable. Therefore, these can be eliminated.
• Headache and blurred vision (Option D) are neurological symptoms. In preeclampsia, these point to cerebral edema and vasospasm, which are hallmarks of severe disease and high risk for eclampsia.
• Conclude that the new onset of neurological symptoms is the most alarming finding and requires immediate action.

Concept Tested & Keywords

• Concept Tested: Recognition of signs indicating the worsening of preeclampsia.
• Stem keywords: pregnant client, mild preeclampsia, worsening, notify the physician
• Lead-in keywords: Which assessment finding indicates
• Clinical cues: A diagnosis of mild preeclampsia sets the context for monitoring disease progression.

Question ID

QGqFNF6utFxPpbEskZGGug

Copy ID

Reference Book

E6 Obstetrics Williams p. 2-9

E6 Medicine Harrison 22e Part 2 p. 1803-1805

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 34-42