At 0600 Jennie is brought to the Labor and Delivery triage area by her sister. The client complains of a pounding headache for the last 12 hours unrelieved by acetaminophen (Tylenol), swollen hands and face for 2 days, and epigastric pain described as bad heartburn. Her sister tells the nurse, "I felt like that when I had toxemia during my pregnancy."
Admission assessment by the nurse reveals: today's weight 182 pounds, T 99.1° F, P 76, R 22, BP 138/88, 4+ pitting edema, and 3+ protein in the urine. Heart rate is regular, and lung sounds are clear. Deep tendon reflexes (DTRs) are 3+ biceps and triceps and 4+ patellar with 1 beat of ankle clonus.
The nurse applies the external fetal monitor, which shows a baseline fetal heart rate of 130, …show more content…

Jennie's sister is very concerned about the swelling (edema) in her sister's face and hands because it seems to be worsening rapidly. She asks the nurse if the healthcare provider will prescribe some of "those water pills" (diuretics) to help get rid of the excess fluid.

4.
Which response by the nurse is correct?
A) "That is a very good idea. I will relay it to the healthcare provider when I call."
INCORRECT
Although it is caring to offer to relay family concerns to the healthcare provider, the physician will make the decision on treatment.

B) "I'm sorry, but it is not the family's place to make suggestions about medical treatment."
INCORRECT
While it is not inappropiate for family members to make suggestions, this answer is not sensitive to the sister's desire to help Jennie.

C) "Let me explain to you about the effect of diuretics on pregnancy."
CORRECT
The sister may have seen diuretics used for treating fluid retention before (for example, in cardiac disease), but may not be aware of how diuretics affect pregnancy. Diuretics decrease blood flow to the placenta by decreasing blood volume. In the case of the preeclamptic client, this is particularly dangerous because the disease has already caused a volume deficit. In addition, the diuretics disrupt normal electrolyte balance and stress kidneys that are already compromised by preeclampsia.