The nurse is continuing to care for the client. Exhibits The nurse is initiating the client’s plan of care. Which of the following interventions should the nurse plan to implement? Select all that apply.

Rationale A. Obtain a 24 hr urine specimen: This is the gold standard for quantifying proteinuria and diagnosing preeclampsia, but a rapid 3+ protein dipstick and severe symptoms/lab findings have already established the diagnosis of severe preeclampsia/HELLP. Treatment (magnesium sulfate, blood pressure control, and preparation for delivery) should not be delayed to wait for a 24-hour collection. B. Monitor intake and output hourly: Clients with preeclampsia are at risk for renal impairment and fluid overload due to vasospasm and endothelial injury. Hourly monitoring ensures adequate renal perfusion (goal urine output ≥30 mL/hr) and prevents complications like pulmonary edema. C. Administer betamethasone: At 31 weeks’ gestation, preterm delivery is likely if maternal or fetal status deteriorates. Betamethasone promotes fetal lung maturity, reducing the risk of respiratory distress syndrome in the newborn. D. Provide a low-stimulation environment: A quiet, dimly lit room minimizes external triggers that can increase CNS irritability and lower the seizure threshold in severe preeclampsia. This is essential for preventing eclampsia. E. Give antihypertensive medication: Severe BP readings (≥160/110 mm Hg) require prompt pharmacologic intervention (e.g., labetalol, hydralazine) to reduce the risk of stroke or placental abruption while maintaining uteroplacental perfusion. F. Maintain bedrest: Activity restriction (preferably left lateral position) enhances uteroplacental blood flow and decreases BP. It also helps prevent falls or injury if the client becomes symptomatic or experiences a seizure. G. Perform a vaginal examination every 12 hr: This is contraindicated in clients with preeclampsia who are not in active labor. Vaginal examinations may induce uterine contractions and increase infection risk without clinical benefit. Cervical assessment should only be done if delivery is imminent or indicated by the provider.