A nurse is assessing a pregnant client at 28 weeks gestation with a pre-pregnancy BMI of 35 kg/m². Which assessment finding would be most concerning and require immediate follow-up?

Proteinuria with elevated BP indicates preeclampsia, a serious complication with higher risk in obese pregnant women. Other findings are within normal limits or less urgent.

Core Nursing Explanation Key Concept Analysis: This question assesses the ability to identify a critical, life-threatening complication of pregnancy—Preeclampsia—and understand the increased risk factors. The client has a pre-pregnancy BMI of 35 kg/m², classifying her as obese, which is a significant risk factor for developing preeclampsia. Preeclampsia is defined by new-onset hypertension (BP ≥140/90 mmHg) and proteinuria (≥1+ on dipstick) after 20 weeks of gestation. It can progress rapidly to eclampsia (seizures) or HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), threatening both maternal and fetal life.

Answer Rationale: Key Point! The combination of elevated blood pressure (148/96 mmHg) and significant Proteinuria (2+) meets the diagnostic criteria for preeclampsia. In a high-risk patient (obesity), this finding is a medical emergency requiring immediate notification of the provider, further evaluation (e.g., 24-hour urine protein, liver function tests, platelet count), and likely intervention to prevent progression.

Distractor Analysis:
Watch out for confusion! Option 1: A BP of 128/82 mmHg is within the normal range for pregnancy. While it should be monitored, it is not an immediate concern.
Option 2: A fasting blood glucose of 95 mg/dL is normal. Although obesity increases the risk for gestational diabetes mellitus (GDM), this value does not indicate hyperglycemia and is not urgent.
Option 4: A weight gain of 12 pounds at 28 weeks is appropriate. The Institute of Medicine (IOM) guidelines recommend a total weight gain of 11-20 lbs for obese women (BMI ≥30). This finding is expected and not concerning.

Related Concepts: This scenario integrates knowledge of prenatal assessment, risk factor identification (obesity), and the pathophysiology of hypertensive disorders of pregnancy. The nurse's role is critical in early detection through vigilant assessment of blood pressure and urinalysis results. Concept Summary

Concept	Key Points
Preeclampsia	Hypertension + Proteinuria after 20 weeks. Risk factors: first pregnancy, obesity, chronic hypertension, multifetal gestation.
Obesity in Pregnancy (BMI ≥30)	Major risk factor for preeclampsia, GDM, cesarean delivery, macrosomia, and thromboembolism.
Normal Prenatal Findings	BP 임상 시나리오 Nursing Clinical Practice Guide Clinical Scenario: You are the nurse in a prenatal clinic. Maria, a 28-year-old G1P0 at 28 weeks, arrives for her check-up. Her pre-pregnancy weight was 210 lbs at 5'4" (BMI 36). She mentions a slight headache but says it's probably from stress. During your assessment, you obtain the vital signs and urine sample as in the question. Nursing Intervention Strategy: 1. Assessment: Immediately re-check the BP in the other arm with the patient sitting and then in left lateral recumbent position. Assess for other symptoms: severe headache, visual disturbances (blurring, spots), epigastric/RUQ pain, sudden edema in face/hands, hyperreflexia, clonus. 2. Action: Notify the physician or midwife immediately with your findings. Do not let the patient leave. This likely warrants hospital admission. 3. Planning/Implementation: If admitted, anticipate orders for: lab work (CBC, liver enzymes, creatinine, 24-hour urine protein), continuous fetal monitoring, IV access, and possibly administration of antihypertensives and MgSO₄ for seizure prophylaxis. 4. Patient Education & Evaluation: Educate the patient on the signs of worsening preeclampsia. Evaluate the effectiveness of interventions by monitoring BP trends, urine output, deep tendon reflexes, and fetal well-being. Patient Safety and Precautions: * Key Point! MgSO₄ Toxicity: If MgSO₄ is administered, monitor closely for signs of toxicity: loss of deep tendon reflexes (first sign), respiratory depression ( 핵심 개념 Preeclampsia — A pregnancy-specific syndrome of new-onset hypertension (≥140/90 mmHg) and proteinuria (≥1+ on dipstick) occurring after 20 weeks of gestation. Body Mass Index — A measure of body fat based on height and weight. In pregnancy, a pre-pregnancy BMI ≥30 kg/m² (obesity) is a major risk factor for complications. Proteinuria — The presence of excess proteins, notably albumin, in the urine. A key diagnostic criterion for preeclampsia, indicating glomerular endothelial damage. Gestational Diabetes Mellitus — Diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes prior to gestation. Screened for with a glucose challenge test. HELLP Syndrome — A severe, life-threatening variant of preeclampsia characterized by Hemolysis, Elevated Liver enzymes, and Low Platelet count. 마이메르시로 국가고시 완벽 대비 기출문제와 상세 해설을 무료로. 내 약점을 분석하고 진도를 관리하며 더 똑똑하게 공부하세요. 무료로 시작하기 App Store Google Play 학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요.