The advanced practice registered nurse (APRN) is seeing a pregnant patient in the clinic for a routine assessment. The pregnancy is at 22 weeks gestation and has had an uncomplicated pregnancy thus far. What findings during the visit today would make the APRN concerned for preeclampsia? Select All That Apply.

Preeclampsia is a pregnancy-specific hypertensive disorder characterized by new-onset hypertension and proteinuria after 20 weeks of gestation. It reflects abnormal placental perfusion leading to widespread endothelial dysfunction and end-organ involvement. Early recognition is essential because it can progress to severe complications affecting the kidneys, liver, brain, and fetus. Diagnostic concern is based on blood pressure elevation and evidence of protein loss in urine. Rationale: A. A blood pressure of 165/115 mmHg is significantly elevated and meets the criteria for severe-range hypertension in pregnancy. Such readings suggest increased systemic vascular resistance and endothelial dysfunction, both characteristic of preeclampsia. This level of hypertension places the patient at high risk for complications such as eclampsia, stroke, and placental insufficiency. B. Elevated white blood cell count is not a diagnostic indicator of preeclampsia and may be seen in normal pregnancy or in response to infection or stress. Preeclampsia is primarily a vascular and placental disorder rather than an infectious or hematologic condition. Therefore, WBC elevation alone does not support the diagnosis. C. Decreased serum creatinine level is typically a normal physiological finding in pregnancy due to increased glomerular filtration rate. In preeclampsia, renal impairment would more commonly result in elevated creatinine levels rather than decreased values. Thus, this finding is not concerning for preeclampsia. D. Protein 1+ on urine dipstick indicates proteinuria, which is a key diagnostic feature of preeclampsia. It reflects glomerular endothelial damage leading to leakage of protein into the urine. When combined with hypertension after 20 weeks gestation, this finding strongly supports the diagnosis of preeclampsia.