A nurse is caring for a female client, age 30, at 37 weeks of gestation in the labor and delivery unit for blood pressure observation. After reviewing the client’s electronic health record, the nurse should identify that the client is at risk for developing which of the following complications?

Choice A rationale: The client exhibits signs consistent with severe preeclampsia including blood pressure above 160/110 mm Hg, 3+ to 4+ deep tendon reflexes, and positive clonus, which are neurological indicators of central nervous system irritability. These findings increase the risk for eclamptic seizures. The headache, visual disturbances (“spots”), and epigastric pain further indicate imminent seizure risk from cerebral edema and vasospasm. Early intervention is crucial to prevent progression to eclampsia. Choice B rationale: Elevated blood pressure combined with preeclampsia significantly raises the risk of abruptio placentae, the premature separation of the placenta from the uterine wall. This occurs because hypertension causes vasospasm and weakening of the placental attachment, increasing placental insufficiency and hemorrhage. The client’s edema and headache indicate vascular endothelial dysfunction, contributing to this risk. Abruptio placentae is a critical obstetric emergency requiring urgent recognition. Choice C rationale: The client’s symptoms and signs of hypertension, headache, epigastric pain, and elevated blood pressure with edema suggest progression toward HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets). Although labs are not provided, the clinical presentation fits the syndrome’s prodromal phase. HELLP syndrome is a severe variant of preeclampsia with hepatic involvement, which can cause multiorgan dysfunction and increased maternal-fetal morbidity if untreated. Choice D rationale: Polyuria, or excessive urine output, is not typical in preeclampsia or related hypertensive disorders; instead, oliguria (decreased urine output below 30 mL/hr) may occur due to renal impairment. The client’s urine output of 25–55 mL/hr borders low normal, signaling possible kidney hypoperfusion, but polyuria is not a recognized complication here. Polyuria is more associated with diabetes or diuretic therapy, not hypertensive pregnancy disorders. Choice E rationale: Ketoacidosis is metabolic acidosis due to ketone accumulation from uncontrolled diabetes or starvation. This client has no history or symptoms of diabetes or starvation, and no laboratory evidence of hyperglycemia or acidosis is reported. Ketoacidosis is not a complication linked to preeclampsia or hypertension in pregnancy and is therefore unlikely in this case. Choice F rationale: Fetal macrosomia is excessive fetal growth usually related to maternal diabetes or obesity. This client has no indications of gestational diabetes or excessive fetal growth; fetal heart rate and contractions are within normal limits, and no mention of abnormal fundal height or ultrasound findings is given. The mild hypertension and edema do not predispose to macrosomia.