Passage / Scenario

Vital Signs (0900): Temperature: 37° C (98.6° F), Heart rate: 90/min, Blood pressure: 158/100 mm Hg, Respiratory rate: 16/min. (1000): Oxygen saturation: 98% on room air, Heart rate: 95/min, Temperature: 37° C (98.6° F), Blood pressure: 162/110 mm Hg, Respiratory rate: 20/min. Diagnostic Results: Hct: 35% (33 to 47%), Hgb: 10 g/dL (11 to 16 g/dL), Urine: 2+ protein, Platelet count: 95,000/mm³ (150,000 to 400,000/mm³), Aspartate aminotransferase (AST): 200 units/L (0 to 35 units/L), Alanine aminotransferase (ALT): 25 units/L (4 to 36 units/L), Total bilirubin: 1.8 mg/dL (0.3 to 1 mg/dL). Medical History: The client is a 26-year-old primigravida at 28 weeks of gestation. She is obese and has no history of hypertension or diabetes mellitus. She presents with elevated blood pressure, peripheral edema, and headaches. Physical Examination Results: The client is alert and oriented to person, place, and time. Her heart rate is regular, and respirations are even and non-labored. She has 3+ deep tendon reflexes and +2 pitting edema of the bilateral lower extremities. The fetal heart rate (FHR) is 140/min with moderate variability.