The nurse is caring for a primigravida client at 34 4/7 weeks gestation, who has come in for a prenatal appointment. Which of the findings would alert the nurse that this patient may be developing preeclampsia?

Choice A rationale Pitting edema occurring at the end of the day is often considered a physiological finding in late pregnancy due to increased venous pressure in the lower extremities and sodium retention. While excessive or generalized edema was previously a diagnostic criterion for preeclampsia, it is no longer specific enough for diagnosis. Dependency edema occurs when hydrostatic pressure exceeds oncotic pressure in the capillaries, which is common in a 34-week gestation primigravida without necessarily indicating a pathological hypertensive state. Choice B rationale Proteinuria is a classic diagnostic marker for preeclampsia, indicating glomerular endothelial damage and increased permeability of the basement membrane in the kidneys. A dipstick reading of 3+ or a quantitative measurement of 300 mg over 24 hours reflects significant renal dysfunction. Normally, pregnant women excrete less than 150 mg of protein daily. The presence of 300 mg or more suggests that the systemic vasospasm associated with preeclampsia is affecting the renal vasculature and compromising the filtration barrier. Choice C rationale A weight gain of 2 pounds over a period of 2 weeks is generally within the expected parameters for the third trimester of pregnancy, where a gain of approximately 1 pound per week is normal. Rapid, pathological weight gain associated with preeclampsia usually exceeds 3 to 5 pounds in a single week and is caused by significant fluid extravasation into the interstitial spaces. This specific rate of gain does not meet the scientific threshold for alerting the nurse to impending preeclampsia. Choice D rationale A blood pressure of 138/84 mmHg does not meet the formal diagnostic criteria for gestational hypertension or preeclampsia. According to clinical guidelines, the blood pressure must be ≥ 140 mmHg systolic or ≥ 90 mmHg diastolic on two separate occasions at least four hours apart. While this reading is on the higher end of the normal range, it does not scientifically confirm the vasospasm and systemic resistance changes required to diagnose preeclampsia in a previously normotensive patient.