A nurse on an antepartum unit is reviewing the medical records for four clients. Which of the following clients should the nurse assess first?
A.
A client who has placenta previa and a hematocrit of 36%.
B.
A client who has hyperemesis gravidarum and a sodium level of 110 mEq/L.
C.
A client who has diabetes mellitus and an HbA1c of 5.8%.
D.
A client who has preeclampsia and a creatinine level of 1.1 mg/dL.
The Correct answer and Explanation is:
The correct answer is B. A client who has hyperemesis gravidarum and a sodium level of 110 mEq/L.
Explanation:
In an antepartum unit, prioritizing client assessments is crucial for ensuring maternal and fetal safety. When evaluating the given options, the nurse must consider both the severity of the client’s condition and the potential for acute complications.
- Client A: Placenta previa with a hematocrit of 36%
- While placenta previa can be concerning, a hematocrit level of 36% is within normal limits, indicating that the client is not currently experiencing significant blood loss.
- Client B: Hyperemesis gravidarum with a sodium level of 110 mEq/L
- This client has a critically low sodium level, indicative of hyponatremia, which can lead to severe complications such as seizures, altered mental status, and cardiac problems. Hyperemesis gravidarum often results in dehydration and electrolyte imbalances, making this client the highest priority for assessment and intervention.
- Client C: Diabetes mellitus with an HbA1c of 5.8%
- An HbA1c of 5.8% suggests good glycemic control in the context of diabetes, which is reassuring. While ongoing monitoring is necessary, this client does not require immediate assessment compared to the others.
- Client D: Preeclampsia with a creatinine level of 1.1 mg/dL
- A creatinine level of 1.1 mg/dL is generally considered normal. Although preeclampsia is a serious condition that requires monitoring, the creatinine level does not indicate acute renal impairment at this time.
Given the potential for acute life-threatening complications associated with hyponatremia in Client B, the nurse must assess this client first. Immediate intervention, such as fluid replacement or sodium correction, may be required to stabilize the patient and prevent further deterioration.