GESTATIONAL HYPERTENSION

Question 1

Hypertension where BP is more than or equal to 140/90 that develops 20 weeks after pregnancy, but returns to normal within 6 weeks of post-partum; proteinuria is not present.

Answer 1

Gestational Hypertension

Question 2

What are the classic signs of pre-eclampsia?

Answer 2

Hypertension and proteinuria

Question 3

Mild pre-eclampsia can be managed at home. Name five important monitoring that must be done at home:

Answer 3

Blood pressure, weight, urine dipstick for protein, signs and symptoms of fetal distress, signs and symptoms of worsening pre-eclampsia

Question 4

Drug of choice for patients with severe pre-eclampsia and eclampsia

Answer 4

Magnesium Sulfate

Question 5

Therapeutic level of magnesium

Answer 5

4 to 8 g/dl

Question 6

What is an important assessment for the nurse to make when a patient is receiving magnesium sulfate in order to prevent toxicity?

Answer 6

Urine output: oliguria (which usually occurs with pre-eclampsia) can cause retention of magnesium and increases risk for toxicity

Question 7

What position should the mother be placed in because it best promotes placental circulation?

Answer 7

Lateral or Side-lying

Question 8

Anti-hypertensive medication of choice for pregnant women with severe pre-eclampsia

Answer 8

Hydralazine: vasodilator that causes vasodilation while increasing cardiac output

Question 9

What important assessments should be made to monitor for s/s of magnesium toxicity? HINT: MAGSO

Answer 9

Mental status
Airway and respiratory status
General reflexes (DTR)
Serum magnesium
Urine output

Question 10

Name three things that can be done to prevent seizure-related injuries to a woman with severe pre-eclampsia?

Answer 10

Padded side rails
Bed kept in lowest position with wheels locked
Have oxygen and suction equipment at bedside

Question 11

A drug that should be kept at bedside to quickly reverse effects of magnesium toxicity

Answer 11

Calcium gluconate

Question 12

A woman is admitted with severe pre-eclampsia. Name three nursing interventions you can do to prevent seizures?

Answer 12

Admit to a quiet room with reduced environmental stimuli
Keep lights low and noise to a minimum
Organise nursing interventions to allow maximum periods of rest

Question 13

What are the conditions that make up the HELLP syndrome, a complication of severe hypertension?

Answer 13

Hemolysis
Elevated liver enzymes
Lowe platelets

Question 14

What is the most prominent symptom of the HELLP syndrome?

Answer 14

RUQ or epigastric pain

Question 15

After a seizure event, the nurse should prepare who which two interventions/monitoring to address a leading cause of maternal morbidity after an eclamptic seizure?

Answer 15

Chest X-ray and ABG - aspiration of gastric contents is a leading cause of maternal morbidity after an eclamptic seizure

Question 16

How would you explain why fetal tachycardia can be seen on a fetal monitor during a seizure episode?

Answer 16

Fetal tachycardia may also occur as the fetus compensates for the period of maternal apnea during the seizures

Question 17

True or False: If a woman with severe pre-eclampsia needs to deliver quickly to prevent onset of seizures, the nurse should prepare her for a C-section.

Answer 17

False. Vaginal birth is the first choice because there is reduce risk of bleeding; remember that coagulation disorders may be present with severe pre-eclampsia.

Question 18

What is the most important side effect of magnesium toxicity

Answer 18

CNS depression, including depression of the respiratory centre

Question 19

What diet is usually prescribed for a woman with mild pre-eclampsia whose condition is being managed at home?

Answer 19

Regular diet without salt or fluid restriction