A nurse is caring for a client at 28 weeks of gestation who has a blood pressure reading of 162/108 mm Hg and 4 hours previously it was 148/98 mm Hg. Which of the following orders should the nurse anticipate receiving? (Select all that apply.)

Choice A rationale A Complete Blood Count (CBC) is anticipated to assess for signs of hemoconcentration (elevated hematocrit due to fluid shifts) and thrombocytopenia (low platelet count, normal range ≈ 150-450 × 109/L), which is indicative of HELLP syndrome, a severe complication of preeclampsia. These parameters are essential for disease classification and management. Choice B rationale Aspartate aminotransferase (AST) and alanine transaminase (ALT) are liver enzymes that are measured to assess for hepatic dysfunction (liver damage), which is a cardinal feature of severe preeclampsia or HELLP syndrome (normal ranges for both are generally ≈ 7-56 units/L). Elevated levels indicate hepatocellular injury and warrant urgent intervention. Choice C rationale Serum creatinine is a crucial marker of renal function (normal range ≈ 0.5-1.1 mg/dL in women). Elevated levels indicate impaired glomerular filtration and acute kidney injury, a common complication of severe preeclampsia due to vasospasm and reduced renal perfusion, requiring careful fluid and medication management. Choice D rationale Fetal ultrasound is anticipated to assess fetal well-being and growth, as severe preeclampsia can cause chronic uteroplacental insufficiency due to vasospasm. This insufficiency can lead to fetal growth restriction and oligohydramnios, necessitating assessment of estimated fetal weight and amniotic fluid index for management planning. Choice E rationale A Contraction Stress Test (CST) is a specialized test to assess fetal reserve but is contraindicated in women with severe hypertension/preeclampsia or a potential for preterm labor due to the risk of precipitating hyperstimulation or placental abruption. The Biophysical Profile (BPP) and Non-stress Test (NST) are preferred methods. Choice F rationale Amniocentesis is a procedure to sample amniotic fluid, typically done to assess for fetal lung maturity if delivery is being considered before 34 weeks gestation. While indicated in some cases, it is not a routine initial order for managing severe preeclampsia at 28 weeks; non-invasive monitoring is prioritized initially.