Exam 1 - Hypertensive Disorders of Pregnancy

Question 1

BP equal to or higher than 140/90 in pregnancy before 20 weeks gestation

Answer 1

Chronic hypertension

Question 2

What is the most common complication of pregnancy?

Answer 2

Hypertensive disorders

Question 3

Blood pressure of 140/90 at or > 20 weeks gestation on two occasions at least 4 hours apart; no associated proteinuria

Answer 3

Gestational HTN

Question 4

Which type of HTN will be diagnosed PRIOR to 20 weeks gestation?

Answer 4

Chronic HTN

Question 5

New onset of hypertension AFTER 20 weeks; BP equal to 140/90 on two occasions at least 4 hours apart OR 160/110
once. Must also have a protein/creatinine ratio
of .3 or higher or 24 hour urine protein of 300mg+

Answer 5

Preeclampsia

Question 6

Which 2 types of HTN disorders are treated with anti-hypertensives?

Answer 6

(1) Chronic HTN
(2) Gestational HTN

Question 7

What are the 2 categories of preeclampsia?

Answer 7

With and without severe features

Question 8

Preeclampsia with severe features includes one of the following:

Answer 8

(1) BP 160/110
(2) abnormal liver function + epigastric pain
(3) renal insufficiency
(4) new onset headache or visual changes
(5) pulmonary edema
(6) thrombocytopenia

Question 9

The key difference between gestational HTN and preeclampsia without severe features is what?

Answer 9

gestational HTN will not have proteinuria and preeclampsia WILL have proteinuria.

Question 10

Most patients WITHOUT severe features deliver at

Answer 10

37w0d

Question 11

Preeclampsia with severe features will deliver when?

Answer 11

Earlier than 37w

Question 12

Name the 3 anti-hypertensives that are used for HTN disorders in pregnancy

Answer 12

(1) Beta blockers (Labetalol) - IV or PO
(2) Ca channel blockers (Nifedipine) - PO
(3) Vasodilator (Hydralazine) - IV

Question 13

One seizure prophylaxis drug is what?

Answer 13

Mg Sulfate - IV

Question 14

Side effects of Mg Sulfate include

Answer 14

(1) Respiratory depression
(2) Fetal intolerance
(3) generalized weakness
(4) flushing/sweating
(5) lack of energy

Question 15

What is the reversal agent for Mg Sulfate?

Answer 15

Ca gluconate

Question 16

Therapeutic range for Mg is what?

Answer 16

5-9

Question 17

Signs of Mg toxicity include…

Answer 17

(1) facial drooping
(2) slurred speech
(3) lack of reflexes
(4) mental confusion
(5) Mg level >9

Question 18

Mg excess is associated with ____ when testing deep tendon reflex

Answer 18

hyporeflexia

Question 19

What indicates a positive clonus?

Answer 19

foot bounces or beats 3-4 times when letting go from the dorsiflexion position

Question 20

New onset of tonic-clonic, focal, or multifocal seizure activity in pregnancy or postpartum with s/s of preeclampsia

Answer 20

Eclampsia

Question 21

What does HELLP stand for in HELLP Syndrome?

Answer 21

Hemolysis
Elevated Liver Enzymes
Low Platelet count

Question 22

A severe variant of preeclampsia is what?

Answer 22

HELLP syndrome

Question 23

What are the main symptoms of HELLP syndrome?

Answer 23

(1) RUQ pain
(2) general malaise
(3) N/V

Question 24

Name a few nursing considerations for when a pregnant person with HTN condition arrives to the hospital

Answer 24

(1) emergency med orders ready
(2) ready or already placed an IV
(3) low-stim environment
(4) safety precautions
(5) frequent assessments (BP, hyperreflexia, clonus, etc.)

Question 25

Name at least 3 factors that put someone at high risk for preeclampsia.

Answer 25

(1) preeclampsia in past pregnancy
(2) carrying more than one fetus
(3) chronic high BP
(4) kidney disease
(5) DM
(6) autoimmune disease

Question 26

Name at least 3 factors that put someone at moderate risk for preeclampsia.

Answer 26

(1) being pregnant for 1st time
(2) BMI over 30
(3) family h/o preeclampsia
(4) age 35+
(5) complications in previous preg
(6) IVR
(7) Black race
(8) Lower income

Question 27

What lab values should be assessed with Mg Sulfate?

Answer 27

(1) Serum creatinine
(2) CBC w/ platelet
(3) urine: PCR
(4) ALT/AST
(5) Mg levels

Question 28

During an eclamptic seizure, what interventions should you complete?

Answer 28

(1) Keep airway patent
(2) Call for assistance
(3) Raise side rails
(4) Observe and record activity

Question 29

After an eclamptic seizure, what should you do?

Answer 29

Do not leave unattended;
Observe for confusion, coma, incontinence;
Use suction as needed;
Administer O2;
Start IV;
Give anticonvulsant as ordered

Question 30

Name at least 3 maternal complications that are associated with HTN disorders.

Answer 30

(1) seizure
(2) stroke
(3) DIC
(4) hepatic failure
(5) acute renal injury
(6) pulmonary edema
(7) placental abruption
(8) retinal injury

Question 31

Name at least 3 fetal injuries associated with HTN disorders.

Answer 31

(1) oligohydramnios
(2) Intrauterine growth restriction
(3) utero-placental insufficiency
(4) prematurity
(5) placental abruption
(6) IUFD