Reduction of Risk PotentialQuestion 2038 of 2368
On the first day after birth, a client has 3+ deep tendon reflexes and sustained clonus. What should the nurse do?
- Document these as normal findings on the first day after birth
- Notify the provider because preeclampsia is suspected
- Apply sequential compression devices to both lower legs
- Massage the lower legs to relieve the muscle tightness
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Correct answer: Notify the provider because preeclampsia is suspected
Clonus or hyperreflexia increases the risk of seizures and requires provider notification for suspected preeclampsia.
Source: Nursing Health Promotion (Open RN, Chippewa Valley Technical College, 2025), Postpartum Care: EXTREMITIES. Licensed under CC BY 4.0.
Practice the topic "Reduction of Risk Potential"Questions last reviewed: 18 October 2026