Editing Maternal and Newborn Nursing – RN Practice Questions (section)

==Question 9==
A charge nurse on a labor and delivery unit receives report on four clients. Which client should the nurse assess '''first'''?
# A client at 39 weeks in active labor reporting an urge to push
# A client 1 hour postpartum with a fundus 2 cm above the umbilicus and deviated to the right
# A client at 30 weeks receiving magnesium sulfate who reports feeling flushed and warm
# A client at 36 weeks with preeclampsia reporting new right upper quadrant pain and nausea

'''Answer:''' 4 (D). The client at 36 weeks with preeclampsia reporting new right upper quadrant pain and nausea.

''Rationale:'' New epigastric or right upper quadrant pain in preeclampsia reflects hepatic capsular distention and suggests HELLP syndrome or impending eclampsia, an unstable and rapidly deteriorating picture. Option 1 is urgent and needs prompt evaluation, but an urge to push in active labor is an expected progression of a physiologic process. Option 2 is a classic full bladder, which is common, easily corrected, and delegable to an assessment that can follow within minutes. Option 3 describes expected effects of magnesium (flushing, warmth, sedation), not toxicity; toxicity would be loss of deep tendon reflexes or respiratory depression. Apply the rule that the unexpected, unstable, and deteriorating client outranks the expected and the correctable.