MIDTERM CH 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications

Question 1

A client at 28 weeks’ gestation presents with a blood pressure of 150/92 mm Hg on two separate occasions, 6 hours apart. No proteinuria is noted. What is the most likely diagnosis?

a. Preeclampsia
b. Chronic hypertension
c. Gestational hypertension
d. Eclampsia

Answer 1

c. Gestational hypertension

Rationale: Gestational hypertension is characterized by a blood pressure higher than 140/90 mm Hg after 20 weeks of gestation in a previously normotensive client, without proteinuria.

Question 2

Which of the following findings would differentiate gestational hypertension from preeclampsia?

a. Elevated liver enzymes
b. Proteinuria
c. Hypertension
d. Hyperreflexia

Answer 2

b. Proteinuria

Rationale: Preeclampsia involves both hypertension and proteinuria, while gestational hypertension is diagnosed in the absence of proteinuria.

Question 3

At what point postpartum does gestational hypertension typically resolve?

a. 6 weeks
b. 8 weeks
c. 12 weeks
d. 20 weeks

Answer 3

c. 12 weeks

Rationale: Gestational hypertension typically resolves by 12 weeks postpartum.

Question 4

A client at 22 weeks of gestation is diagnosed with hypertension and reports a history of elevated blood pressure prior to pregnancy. What is the most appropriate diagnosis?

a. Chronic hypertension
b. Gestational hypertension
c. Preeclampsia
d. White coat hypertension

Answer 4

a. Chronic hypertension

Rationale: Hypertension present before 20 weeks of gestation or prior to pregnancy is classified as chronic hypertension.

Question 5

A nurse is caring for a client with gestational hypertension. Which statement indicates that the client understands the condition?

a. “This condition is likely to resolve after delivery.”
b. “I will need to take antihypertensives for the rest of my life.”
c. “This condition always progresses to preeclampsia.”
d. “I am at no risk for developing complications.”

Answer 5

a. “This condition is likely to resolve after delivery.”

Rationale: Gestational hypertension typically resolves after delivery, but it can progress to preeclampsia in some cases.

Question 6

Which client is at highest risk for developing gestational hypertension?

a. A 25-year-old gravida 2 para 1 with a history of chronic hypertension

b. A 30-year-old primigravida with no medical history

c. A 20-year-old gravida 3 para 2 with obesity

d. A 40-year-old primigravida with a history of gestational diabetes

Answer 6

d. A 40-year-old primigravida with a history of gestational diabetes

Rationale: Advanced maternal age and a history of gestational diabetes increase the risk for gestational hypertension.

Question 7

What is the primary criterion for diagnosing gestational hypertension?

a. Systolic blood pressure > 140 mm Hg or diastolic > 90 mm Hg before 20 weeks
b. Hypertension with proteinuria after 20 weeks
c. Hypertension without proteinuria after 20 weeks
d. Severe headache and blurred vision

Answer 7

c. Hypertension without proteinuria after 20 weeks

Rationale: Gestational hypertension is defined as new-onset hypertension (≥140/90 mm Hg) after 20 weeks of gestation in the absence of proteinuria.

Question 8

What is the definition of gestational hypertension?

A. Hypertension with proteinuria after the 20th week of pregnancy

B. Hypertension without proteinuria after the 20th week of pregnancy

C. Hypertension before the 20th week of pregnancy

D. Hypertension after childbirth

Answer 8

B. Hypertension without proteinuria after the 20th week of pregnancy

Rationale: Gestational hypertension is defined as the onset of hypertension after the 20th week of pregnancy without protein in the urine and normal lab results.

Question 9

Which blood pressure reading meets the criteria for gestational hypertension?

A. SBP 130 or DBP 80
B. SBP 135 or DBP 85
C. SBP 140 or DBP 90
D. SBP 120 or DBP 70

Answer 9

C. SBP 140 or DBP 90

Rationale: Gestational hypertension is diagnosed with a systolic blood pressure (SBP) greater than 140 mmHg or a diastolic blood pressure (DBP) greater than 90 mmHg.

Question 10

At what gestational age is gestational hypertension most commonly diagnosed?

A. At or before 20 weeks

B. At or after 37 weeks

C. Between 30 to 36 weeks

D. After childbirth

Answer 10

B. At or after 37 weeks

Rationale: Gestational hypertension most commonly occurs at or after 37 weeks of gestation.

Question 11

Which group has the highest incidence of gestational hypertension?

A. Primigravidas
B. Women with twins
C. Women with a history of chronic hypertension
D. Multiparous women

Answer 11

D. Multiparous women

Rationale: Multiparous women have a higher incidence of gestational hypertension, ranging from 6% to 17%.

Question 12

What potential complication should women with gestational hypertension be monitored for?

A. Diabetes
B. Anemia
C. Preeclampsia
D. Preterm labor

Answer 12

C. Preeclampsia

Rationale: Women with gestational hypertension should be monitored for signs of preeclampsia, such as checking urine, lab results, deep tendon reflexes (DTR), and symptoms.

Question 13

What is the most frequent cause of hypertension during pregnancy?

A. Chronic hypertension
B. Pre-existing hypertension
C. Preeclampsia
D. Gestational hypertension

Answer 13

D. Gestational hypertension

Rationale: The most frequent cause of hypertension during pregnancy is gestational hypertension.

Question 14

What defines gestational hypertension during pregnancy?

a) Onset of hypertension with proteinuria and abnormal labs after 20 weeks

b) Blood pressure greater than 140/90 before 20 weeks of pregnancy

c) Elevated systolic blood pressure (SBP) greater than 140 or diastolic blood pressure (DBP) greater than 90 without proteinuria or abnormal labs after 20 weeks

d) Blood pressure of 160/110 with proteinuria after 20 weeks

Answer 14

c) Elevated systolic blood pressure (SBP) greater than 140 or diastolic blood pressure (DBP) greater than 90 without proteinuria or abnormal labs after 20 weeks

Rationale: Gestational hypertension is characterized by elevated blood pressure after 20 weeks of pregnancy, without protein in the urine or abnormal lab results.

Question 15

At what point in pregnancy is gestational hypertension most common?

a) Before 20 weeks

b) At or after 37 weeks

c) During the first trimester

d) After the postpartum period

Answer 15

b) At or after 37 weeks

Rationale: Gestational hypertension is most commonly diagnosed at or after 37 weeks of pregnancy, when blood pressure levels exceed 140/90 mmHg without proteinuria.

Question 16

What is the potential outcome if gestational hypertension persists postpartum?

a) Diagnosis of preeclampsia

b) Normalization of blood pressure

c) Diagnosis of chronic hypertension

d) Development of gestational diabetes

Answer 16

c) Diagnosis of chronic hypertension

Rationale: If gestational hypertension persists after delivery, it is reclassified as chronic hypertension, as the blood pressure remains elevated beyond the postpartum period.

Question 17

Which of the following assessments should be included in monitoring a woman with gestational hypertension? (Select all that apply)

a) Check for protein in the urine

b) Monitor labs for abnormalities

c) Measure deep tendon reflexes (DTR)

d) Monitor for signs of preeclampsia

e) Monitor for gestational diabetes

Answer 17

a) Check for protein in the urine

b) Monitor labs for abnormalities

c) Measure deep tendon reflexes (DTR)

d) Monitor for signs of preeclampsia

Rationale: Women with gestational hypertension should be monitored for signs of preeclampsia, which includes checking for proteinuria, assessing lab values, and evaluating deep tendon reflexes for hyperreflexia, a common sign of preeclampsia. Monitoring for gestational diabetes is not specific to hypertension.

Question 18

According to ACOG, what blood pressure levels classify as severe chronic hypertension?

A. SBP > 140 or DBP > 90 mm Hg

B. SBP > 150 or DBP > 95 mm Hg

C. SBP > 160 or DBP > 100 mm Hg

D. SBP > 160 or DBP > 110 mm Hg

Answer 18

D. SBP > 160 or DBP > 110 mm Hg

Rationale: ACOG classifies severe chronic hypertension in pregnancy as systolic BP higher than 160 mm Hg or diastolic BP higher than 110 mm Hg.

Question 19

What is the recommended course of action if maternal blood pressure exceeds 160/100 mm Hg?

A. Antihypertensive drug treatment
B. No treatment necessary
C. Lifestyle changes only
D. Monitoring blood pressure only

Answer 19

A. Antihypertensive drug treatment

Rationale: If maternal blood pressure exceeds 160/100 mm Hg, drug treatment is recommended to prevent long-term sequelae such as stroke or acute renal failure.

Question 20

Which of the following groups has a higher prevalence of chronic hypertension in pregnancy?

A. Younger women with a low BMI
B. Older women with a high BMI
C. Women of average weight
D. Women who are underweight

Answer 20

B. Older women with a high BMI

Rationale: The prevalence of chronic hypertension varies according to age, race, and BMI, with higher prevalence seen in older women with a high BMI.

Question 21

Why is antihypertensive therapy not generally recommended for mild chronic hypertension during pregnancy?

A. It is not effective
B. It increases the risk of preeclampsia
C. It causes severe hypertension
D. It can lead to intrauterine growth restriction

Answer 21

D. It can lead to intrauterine growth restriction

Rationale: Pharmacologic treatment of mild hypertension does not reduce the likelihood of developing preeclampsia and increases the likelihood of intrauterine growth restriction.

Question 22

Which statement is true regarding chronic hypertension and pregnancy?

A. It always resolves after pregnancy
B. It only occurs in the third trimester
C. It is diagnosed before 20 weeks’ gestation
D. It is only seen in women with a history of hypertension

Answer 22

C. It is diagnosed before 20 weeks’ gestation

Rationale: Chronic hypertension is diagnosed before 20 weeks’ gestation and is often pre-existing before pregnancy.

Question 23

Which age group is 10 times more likely to experience chronic hypertension in pregnancy compared to younger women?

A. Women aged 20-30 years
B. Women aged 30-40 years
C. Women aged 40 years or older
D. Women younger than 20 years

Answer 23

C. Women aged 40 years or older

Rationale: Women aged 40 years or older are 10 times more likely to experience chronic hypertension compared to those younger than 20 years.

Question 24

What are the increased risks associated with chronic hypertension during pregnancy?

A. Increased risk for preterm delivery and fetal growth restriction

B. Increased risk for gestational diabetes

C. Increased risk for anemia

D. Increased risk for excessive weight gain

Answer 24

A. Increased risk for preterm delivery and fetal growth restriction

Rationale: Chronic hypertension is associated with an increased risk for preterm delivery and fetal growth restriction.

Question 25

What is a potential risk for patients with chronic hypertension during pregnancy?

A. Placental abruption
B. Gestational diabetes
C. Anemia
D. Polyhydramnios

Answer 25

A. Placental abruption

Rationale: Patients with chronic hypertension are at risk for placental abruption, which is when the placenta detaches from the uterus.

Question 26

What is the impact of chronic hypertension on perinatal mortality?

A. No impact
B. Decreases mortality
C. Unpredictable impact
D. Increases mortality

Answer 26

D. Increases mortality

Rationale: Chronic hypertension is associated with increased perinatal mortality (fetal death).

Question 27

What is the risk of intrauterine fetal demise (IUFD) associated with chronic hypertension?

A. Low risk
B. Moderate risk
C. High risk
D. No risk

Answer 27

C. High risk

Rationale: Patients with chronic hypertension are at high risk for intrauterine fetal demise (IUFD).

Question 28

Which fetal growth complication is associated with chronic hypertension?

A. Macrosomia
B. Normal growth
C. LGA (Large for Gestational Age)
D. Small for Gestational Age (SGA)

Answer 28

D. Small for Gestational Age (SGA)

Rationale: Chronic hypertension increases the risk of the fetus being Small for Gestational Age (SGA).

Question 29

Which vital signs and assessments are crucial for managing chronic hypertension in pregnant patients?

A. Vital signs, DTRs, clonus, I&O, level of consciousness
B. Pulse rate, temperature, weight, skin turgor
C. Respiratory rate, capillary refill, bowel sounds, reflexes
D. Hemoglobin levels, white blood cell count, platelet count, height

Answer 29

A. Vital signs, DTRs, clonus, I&O, level of consciousness

Rationale: The crucial assessments include vital signs, deep tendon reflexes (DTRs), clonus, intake and output (I&O), and level of consciousness to monitor the patient’s condition effectively.

Question 30

Chronic hypertension in pregnancy is strongly correlated with an increased risk of which condition postpartum?

a) Renal failure
b) Gestational diabetes
c) Preterm labor
d) Placenta accreta

Answer 30

a) Renal failure

Rationale: Postpartum complications from chronic hypertension can include renal failure, in addition to other cardiovascular complications.

Question 31

What is the correlation between chronic hypertension and cardiovascular disease?

a) Chronic hypertension is unrelated to cardiovascular disease risk.

b) Chronic hypertension reduces the risk of cardiovascular disease.

c) Cardiovascular disease risk is only increased after delivery in women with chronic hypertension.

d) There is a strong correlation between chronic hypertension and increased cardiovascular disease risk.

Answer 31

d) There is a strong correlation between chronic hypertension and increased cardiovascular disease risk.

Rationale: Chronic hypertension during pregnancy is strongly correlated with an increased risk of developing cardiovascular disease later in life.

Question 32

Which complication is NOT directly associated with chronic hypertension during pregnancy?

a) Intrauterine fetal demise (IUFD)
b) Placental abruption
c) Eclampsia
d) Small for gestational age (SGA)

Answer 32

c) Eclampsia

Rationale: Eclampsia is more closely related to preeclampsia, not chronic hypertension. Chronic hypertension is associated with other risks like placental abruption, IUFD, and SGA.

Question 33

What is a potential postpartum complication for a woman with chronic hypertension?

a) Pulmonary edema
b) Anemia
c) Hyperthyroidism
d) Gestational diabetes

Answer 33

a) Pulmonary edema

Rationale: Women with chronic hypertension are at increased risk for postpartum complications such as pulmonary edema, along with heart failure and renal failure.

Question 34

What is the most common cause of target organ damage in women with chronic hypertension?

a) Renal failure
b) Cardiovascular disease
c) Cerebral hemorrhage
d) Placental insufficiency

Answer 34

b) Cardiovascular disease

Rationale: The most common cause of target organ damage in women with chronic hypertension is cardiovascular disease, which is strongly linked to high blood pressure.

Question 35

How does chronic hypertension affect fetal growth?

a) It increases the likelihood of intrauterine growth restriction (IUGR).
b) It increases the likelihood of fetal macrosomia.
c) It has no effect on fetal growth.
d) It accelerates fetal growth.

Answer 35

a) It increases the likelihood of intrauterine growth restriction (IUGR).

Rationale: Chronic hypertension increases the risk of fetal growth restriction (IUGR) and may lead to small for gestational age (SGA) infants due to placental insufficiency.

Question 36

Which of the following is NOT a typical risk of chronic hypertension during pregnancy?

a) Increased perinatal mortality
b) Placental abruption
c) Increased likelihood of full-term delivery
d) Preterm birth

Answer 36

c) Increased likelihood of full-term delivery

Rationale: Chronic hypertension increases the risk of preterm birth and other complications but does not increase the likelihood of full-term delivery.

Question 37

What should healthcare providers monitor closely in a patient with chronic hypertension during pregnancy?

a) Blood glucose levels only
b) Uterine contractions and fetal positioning
c) Blood pressure, urine protein levels, and signs of preeclampsia
d) Maternal weight and hydration levels

Answer 37

c) Blood pressure, urine protein levels, and signs of preeclampsia

Rationale: Women with chronic hypertension need careful monitoring of their blood pressure, urine protein levels, and signs of preeclampsia to manage potential complications and protect both maternal and fetal health.

Question 38

Why are ACE inhibitors and ARBs contraindicated in pregnant patients with chronic hypertension?

A. They can cause hypoglycemia
B. They are ineffective during pregnancy
C. They can cause birth defects
D. They lower blood pressure too rapidly

Answer 38

C. They can cause birth defects

Rationale: ACE inhibitors and ARBs need to be switched in pregnant patients because they can cause birth defects.

Question 39

When is antihypertensive medication administration indicated for pregnant patients with chronic hypertension?

A. SBP > 140 or DBP > 90 mm Hg

B. SBP > 150 or DBP > 100 mm Hg

C. SBP > 160 or DBP > 110 mm Hg

D. SBP > 170 or DBP > 120 mm Hg

Answer 39

C. SBP > 160 or DBP > 110 mm Hg

Rationale: Antihypertensive medication administration is indicated for systolic blood pressure (SBP) greater than 160 mm Hg or diastolic blood pressure (DBP) greater than 110 mm Hg.

Question 40

Which antihypertensive medications are commonly used to manage chronic hypertension in pregnancy?

A. Metoprolol, Verapamil, Propranolol
B. Hydralazine, Labetalol, Nifedipine
C. Losartan, Enalapril, Candesartan
D. Amlodipine, Clonidine, Atenolol

Answer 40

B. Hydralazine, Labetalol, Nifedipine

Rationale: Hydralazine, Labetalol, and Nifedipine are commonly used to manage chronic hypertension in pregnancy.

Question 41

Which of the following assessments should be closely monitored in a pregnant patient with chronic hypertension? (Select all that apply)

a) Vital signs
b) Deep tendon reflexes (DTRs)
c) Clonus
d) Intake and output (I&O)
e) Level of consciousness

Answer 41

all of the choices are correct

Question 42

What should be monitored starting at 28 weeks for a pregnant patient with chronic hypertension?

a) Weekly urine protein levels
b) Fetal surveillance including growth ultrasound
c) Only blood pressure readings
d) Maternal weight gain

Answer 42

b) Fetal surveillance including growth ultrasound

Rationale: Fetal surveillance, including growth ultrasounds, is important starting at 28 weeks to monitor for potential complications like intrauterine growth restriction (IUGR) in pregnancies complicated by chronic hypertension.

Question 43

Which symptom would most likely indicate a worsening of chronic hypertension during pregnancy?

a) Decreased fetal movement
b) Improved blood pressure readings
c) Elevated urinary output
d) Increased maternal weight loss

Answer 43

a) Decreased fetal movement

Rationale: Decreased fetal movement could be a sign of worsening chronic hypertension or its complications, such as fetal growth restriction or placental insufficiency, necessitating further evaluation.

Question 44

Which of the following is true regarding preeclampsia? (Select all that apply)

A. It is characterized by new-onset hypertension.
B. It is always accompanied by proteinuria.
C. It can target multiple organ systems, including cardiovascular, hepatic, renal, and CNS.
D. It is one of the leading causes of maternal morbidity and mortality worldwide.

Answer 44

A. It is characterized by new-onset hypertension.
C. It can target multiple organ systems, including cardiovascular, hepatic, renal, and CNS.
D. It is one of the leading causes of maternal morbidity and mortality worldwide.

Rationale: Preeclampsia is described as new-onset hypertension (A) that may be accompanied by proteinuria and/or maternal organ dysfunction affecting multiple systems (C), and it remains a leading cause of maternal morbidity and mortality worldwide (D). Proteinuria is not always present (B).

Question 45

Which organ systems are commonly targeted in preeclampsia? (Select all that apply)

A. Respiratory system
B. Cardiovascular system
C. Hepatic system
D. Renal system
E. Central nervous system

Answer 45

B. Cardiovascular system
C. Hepatic system
D. Renal system
E. Central nervous system

Rationale: Preeclampsia targets the cardiovascular, hepatic, renal, and central nervous systems.

Question 46

What clinical presentation is indicative of preeclampsia?

A. Chronic hypertension without proteinuria

B. New-onset hypertension with or without proteinuria and organ dysfunction

C. Hypertension only during labor

D. Proteinuria with or without hypertension and organ dysfunction

Answer 46

B. New-onset hypertension with or without proteinuria and organ dysfunction

Rationale: Preeclampsia is characterized by new-onset hypertension with or without proteinuria and maternal organ dysfunction.

Question 47

At what point in gestation do hypertension (HTN) and proteinuria typically develop in preeclampsia?

A. Before 20 weeks gestation
B. After 20 weeks gestation
C. At the time of delivery
D. During the first trimester

Answer 47

B. After 20 weeks gestation

Question 48

During which period of pregnancy does preeclampsia most commonly manifest?

A. First trimester
B. First half of pregnancy
C. Second half of pregnancy
D. Third trimester

Answer 48

C. Second half of pregnancy

Rationale: Preeclampsia most commonly manifests in the second half of pregnancy.

Question 49

Which of the following symptoms are associated with the widespread pathologic changes seen in preeclampsia? (Select all that apply)

A. Pulmonary edema
B. Hyperglycemia
C. Oliguria
D. Seizures
E. Thrombocytopenia
F. Abnormal liver enzymes

Answer 49

A. Pulmonary edema
C. Oliguria
D. Seizures
E. Thrombocytopenia
F. Abnormal liver enzymes

Rationale: Preeclampsia can cause pulmonary edema (A), oliguria (C), seizures (D), thrombocytopenia (E), and abnormal liver enzymes (F). Hyperglycemia is not a typical symptom.

Question 50

What is a hallmark diagnostic criterion for preeclampsia?

a) Proteinuria and elevated liver enzymes before 20 weeks gestation

b) Hypertension and proteinuria after 20 weeks gestation

c) Severe edema and hypotension before 20 weeks gestation

d) Elevated blood pressure with no proteinuria after 20 weeks gestation

Answer 50

b) Hypertension and proteinuria after 20 weeks gestation

Rationale: Preeclampsia is characterized by the development of hypertension and proteinuria after 20 weeks gestation.

Question 51

What effect does decreased kidney perfusion have in preeclampsia?

A. Decreased glomerular filtration rate and increased serum levels of sodium, BUN, uric acid, and creatinine

B. Decreased urine output and increased serum levels of sodium, BUN, uric acid, and creatinine

C. Decreased serum sodium levels and increased serum levels of sodium, BUN, uric acid, and creatinine

D. Decreased renal function and increased serum levels of sodium, BUN, uric acid, and creatinine

Answer 51

A. Decreased glomerular filtration rate and increased serum levels of sodium, BUN, uric acid, and creatinine

Rationale: Decreased kidney perfusion leads to a decreased glomerular filtration rate and increased serum levels of sodium, blood urea nitrogen (BUN), uric acid, and creatinine.

Question 52

What is a known contributing factor to the development of preeclampsia?

A. Exact cause unknown

B. High maternal BMI

C. Low maternal glucose levels

D. High maternal cholesterol levels

Answer 52

A. Exact cause unknown

Rationale: The exact cause of preeclampsia is still unknown, despite extensive research.

Question 53

What abnormality in placental development is associated with preeclampsia?

A. Excessive placental growth
B. Abnormal placental implantation
C. Increased placental blood flow
D. Normal trophoblast function

Answer 53

B. Abnormal placental implantation

Rationale: Preeclampsia is associated with abnormal placental implantation, where trophoblasts fail to convert high-resistance vessels to low-resistance vessels, reducing placental blood flow.

Question 54

What is the definitive cure for preeclampsia/eclampsia?

A. Antihypertensive medication
B. Bed rest
C. Low-sodium diet
D. Delivery of the placenta

Answer 54

D. Delivery of the placenta

Rationale: The definitive cure for preeclampsia/eclampsia is the delivery of the placenta. The resolution of symptoms following the expulsion of the placenta supports theories related to its influence on the disease.

Question 55

When should daily low-dose aspirin be initiated for women at high risk of developing preeclampsia?

A. From 12 weeks’ gestation until delivery
B. From the first trimester until 20 weeks’ gestation
C. From 20 weeks’ gestation until 30 weeks’ gestation
D. From 30 weeks’ gestation until delivery

Answer 55

A. From 12 weeks’ gestation until delivery

Rationale: Recent studies recommend the prevention of preeclampsia with daily low-dose aspirin (75 to 150 mg) from 12 weeks’ gestation until delivery for women considered high risk.

Question 56

Which of the following are risk factors for the development of preeclampsia? (Select all that apply)

A. Multifetal gestation
B. Previous pregnancy with preeclampsia
C. Chronic hypertension
D. Renal disease
E. Obesity

Answer 56

all of the choices are correct

Question 57

How is a mild case of preeclampsia typically managed?

A. Inpatient monitoring with continuous fetal surveillance
B. Outpatient monitoring of blood pressure and serial assessments
C. Immediate delivery of the fetus
D. No intervention needed

Answer 57

B. Outpatient monitoring of blood pressure and serial assessments

Rationale: A mild case of preeclampsia is typically managed with outpatient monitoring of blood pressure and serial assessments.

Question 58

At what gestational age is delivery recommended for non-severe hypertensive disorders in pregnancy?

A. 32 weeks
B. 34 weeks
C. 37 weeks
D. 40 weeks

Answer 58

C. 37 weeks

Rationale: For non-severe hypertensive disorders in pregnancy, delivery is recommended at 37 weeks.

Question 59

What intervention is recommended for a fetus less than 36 weeks’ gestation in a woman with preeclampsia?

A. Immediate cesarean section
B. Bed rest with pain medication (Motrin)
C. Administration of antenatal steroids (betamethasone)
D. Increased dietary intake of calcium

Answer 59

C. Administration of antenatal steroids (betamethasone)

Rationale: For a fetus less than 36 weeks’ gestation in a woman with preeclampsia, administering antenatal steroids (betamethasone IM x 2 doses 24 hours apart) is recommended to promote fetal lung maturity.

Question 60

What position is recommended for a woman with mild elevation in blood pressure due to preeclampsia?

A. Supine position
B. Lateral recumbent position
C. Prone position
D. Fowler’s position

Answer 60

B. Lateral recumbent position

Rationale: The lateral recumbent position is recommended to improve uteroplacental blood flow, reduce blood pressure, and promote diuresis.

Question 61

What additional prenatal visits and diagnostic tests are recommended for women with mild preeclampsia? (Select all that apply)

A. CBC
B. Clotting studies
C. Liver enzymes
D. Platelet levels
E. Blood glucose levels

Answer 61

A. CBC
B. Clotting studies
C. Liver enzymes
D. Platelet levels

Rationale: Increased frequency of prenatal visits and diagnostic tests such as CBC, clotting studies, liver enzymes, and platelet levels are recommended for monitoring.

Question 62

What is the primary placental abnormality in the pathophysiology of preeclampsia?

a) Excessive placental blood flow

b) High-resistance uterine vessels not converting to low-resistance vessels

c) Complete placental detachment from the uterine wall

d) Excessive angiogenesis in placental vessels

Answer 62

b) High-resistance uterine vessels not converting to low-resistance vessels

Rationale: In preeclampsia, the trophoblasts fail to convert high-resistance uterine vessels into low-resistance vessels, leading to reduced placental blood flow and subsequent ischemia.

Question 63

What triggers endothelial dysfunction in preeclampsia?

a) Increased blood pressure in the mother

b) Excessive placental growth

c) Decreased maternal oxygenation

d) Placental ischemia releasing factors into maternal circulation

Answer 63

d) Placental ischemia releasing factors into maternal circulation

Rationale: Placental ischemia results in the release of placental factors into maternal circulation, which triggers endothelial dysfunction and the systemic complications of preeclampsia.

Question 64

Which of the following best describes the systemic effects of preeclampsia?

a) It only affects placental blood flow.

b) It primarily causes gastrointestinal symptoms.

c) It leads to multi-organ failure due to widespread endothelial dysfunction.

d) It results in low fetal blood pressure with minimal maternal effects.

Answer 64

c) It leads to multi-organ failure due to widespread endothelial dysfunction.

Rationale: Preeclampsia results in multi-organ failure caused by endothelial dysfunction, which is triggered by placental ischemia and systemic inflammatory responses.

Question 65

What role do trophoblasts play in the development of preeclampsia?

a) They stimulate excessive placental blood flow.

b) They fail to convert high-resistance uterine vessels to low-resistance vessels.

c) They increase placental oxygenation.

d) They reduce inflammatory responses in maternal circulation.

Answer 65

b) They fail to convert high-resistance uterine vessels to low-resistance vessels.

Rationale: The failure of trophoblasts to convert high-resistance vessels to low-resistance vessels is a key placental abnormality in preeclampsia, leading to reduced blood flow and placental ischemia.

Question 66

What are the blood pressure criteria required for a diagnosis of preeclampsia?

a) SBP > 120 or DBP > 80 on two occasions at least 4 hours apart

b) SBP > 130 or DBP > 85 on a single reading

c) SBP > 140 or DBP > 90 on two occasions at least 4 hours apart

d) SBP > 160 or DBP > 110 on two occasions

Answer 66

c) SBP > 140 or DBP > 90 on two occasions at least 4 hours apart

Rationale: Preeclampsia is diagnosed when systolic blood pressure is greater than 140 mmHg or diastolic blood pressure is greater than 90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation.

Question 67

Which of the following urine findings meets the criteria for proteinuria in preeclampsia?

a) Protein/creatinine ratio of 0.5 mg/dL
b) Dipstick reading of +1 in the absence of quantitative testing
c) 24-hour urine protein of 250 mg/dL
d) Absence of proteinuria

Answer 67

b) Dipstick reading of +1 in the absence of quantitative testing

Rationale: Proteinuria is defined as >300 mg/dL in a 24-hour urine specimen, a protein/creatinine ratio >0.3 mg/dL, or a dipstick reading of +1 when quantitative testing is not available.

Question 68

What criteria can be used to diagnose preeclampsia in the absence of proteinuria? (Select all that apply)

a) Thrombocytopenia (platelet count <100,000)
b) Impaired liver function with LFTs twice the baseline value
c) Pulmonary edema
d) Hyperglycemia
e) New-onset headache or visual disturbances

Answer 68

a) Thrombocytopenia (platelet count <100,000)
b) Impaired liver function with LFTs twice the baseline value
c) Pulmonary edema
e) New-onset headache or visual disturbances

Rationale: In the absence of proteinuria, preeclampsia can be diagnosed with other criteria such as thrombocytopenia, elevated liver enzymes, pulmonary edema, or cerebral symptoms (headache or visual disturbances). Hyperglycemia is not a diagnostic criterion.

Question 69

What is considered an abnormal creatinine level for diagnosing preeclampsia?

a) Creatinine >1.0 mg/dL

b) Creatinine >1.1 mg/dL or doubling of the baseline value

c) Creatinine >2.0 mg/dL

d) Creatinine >0.8 mg/dL

Answer 69

b) Creatinine >1.1 mg/dL or doubling of the baseline value

Rationale: Preeclampsia can be diagnosed with new-onset renal insufficiency if serum creatinine exceeds 1.1 mg/dL or doubles from the baseline value.

Question 70

Which laboratory finding supports the diagnosis of preeclampsia?

a) Platelet count >150,000
b) Hemoglobin >12 g/dL
c) Blood glucose >110 mg/dL
d) ALT and AST levels twice the baseline value

Answer 70

d) ALT and AST levels twice the baseline value

Rationale: Elevated liver enzymes (AST/ALT) at twice the baseline value are indicative of impaired liver function, supporting a diagnosis of preeclampsia in the absence of proteinuria.

Question 71

Which clinical symptom is consistent with preeclampsia?

a) Headache unresponsive to analgesics and visual disturbances
b) Persistent cough and fever
c) Rapid weight loss
d) Increased fetal movement

Answer 71

a) Headache unresponsive to analgesics and visual disturbances

Rationale: Cerebral symptoms such as headache unresponsive to treatment and visual disturbances are diagnostic criteria for preeclampsia and indicate possible severe disease.

Question 72

Which of the following are risk factors for developing preeclampsia? (Select all that apply)

a) Primiparity
b) Obesity
c) Chronic hypertension
d) Maternal age <20
e) Thrombophilia

Answer 72

a) Primiparity
b) Obesity
c) Chronic hypertension
e) Thrombophilia

Rationale: Primiparity, obesity, chronic hypertension, and thrombophilia are established risk factors for preeclampsia. Maternal age <20 is not listed as a specific risk factor, though extremes of age can increase risk.

Question 73

Which maternal age group is at the highest risk for preeclampsia, especially with comorbid conditions?

a) Women under 20 years old
b) Women between 20-30 years old
c) Women over 40 years old
d) Women aged 35 or older with comorbidities

Answer 73

d) Women aged 35 or older with comorbidities

Rationale: Maternal age >40 or 35 with comorbid conditions such as diabetes, chronic hypertension, or renal disease significantly increases the risk of preeclampsia.

Question 74

Which comorbid conditions increase the likelihood of developing preeclampsia? (Select all that apply)

a) Diabetes
b) SLE (lupus)
c) Asthma
d) Renal disease
e) Thrombophilia

Answer 74

a) Diabetes
b) SLE (lupus)
d) Renal disease
e) Thrombophilia

Rationale: Diabetes (type 1 and 2), systemic lupus erythematosus (SLE), renal disease, and thrombophilia are comorbid conditions that increase the risk of preeclampsia. Asthma is not directly associated with increased risk.

Question 75

Which patient is at the highest risk for developing preeclampsia?

a) A 30-year-old multiparous woman with no medical history
b) A 28-year-old primigravida with a BMI of 40 and chronic hypertension
c) A 22-year-old woman pregnant with her second child and a family history of gestational diabetes
d) A 41-year-old woman with no comorbidities

Answer 75

b) A 28-year-old primigravida with a BMI of 40 and chronic hypertension

Rationale: Primiparity, obesity (BMI >30), and chronic hypertension are all significant risk factors for preeclampsia, placing this patient at the highest risk compared to the others.

Question 76

A pregnant patient with a history of preeclampsia in a prior pregnancy asks if she is at risk again. What should the nurse include in the response?

a) “You are at higher risk for preeclampsia if you also have conditions like diabetes or chronic hypertension.”

b) “Your risk is low since preeclampsia usually does not recur in subsequent pregnancies.”

c) “A history of preeclampsia does not increase your risk of preeclampsia in this pregnancy.”

d) “Preeclampsia is only a concern in first pregnancies and won’t occur again.”

Answer 76

a) “You are at higher risk for preeclampsia if you also have conditions like diabetes or chronic hypertension.”

Rationale: A history of preeclampsia increases the likelihood of recurrence, especially when comorbid conditions such as diabetes, chronic hypertension, or renal disease are present.

Question 77

What is the primary goal of nursing management for a patient with preeclampsia?

a) Prevent fetal distress and ensure cesarean delivery.
b) Manage symptoms and prevent further maternal organ damage.
c) Ensure maternal safety and deliver a healthy baby near term.
d) Minimize weight gain during pregnancy.

Answer 77

c) Ensure maternal safety and deliver a healthy baby near term.

Rationale: The primary goal of nursing management in preeclampsia is to prioritize maternal safety and achieve a healthy delivery close to term to reduce complications for both mother and baby.

Question 78

Which of the following assessments is critical in monitoring a patient with preeclampsia? (Select all that apply)

a) Pitting edema
b) Deep tendon reflexes (DTRs)
c) Clonus
d) Capillary refill time
e) Fetal heart rate

Answer 78

a) Pitting edema
b) Deep tendon reflexes (DTRs)
c) Clonus

Rationale: Pitting edema, hyperreflexia (DTRs), and clonus are essential assessments in preeclampsia to monitor for worsening symptoms and progression toward severe disease.

Question 79

Which diagnostic test would indicate worsening preeclampsia?

a) Decreased serum creatinine
b) Increased platelets
c) Elevated lactate dehydrogenase (LDH)
d) Normal uric acid levels

Answer 79

c) Elevated lactate dehydrogenase (LDH)

Rationale: Elevated LDH levels indicate tissue damage or hemolysis, which can signify worsening preeclampsia or progression toward HELLP syndrome.

Question 80

What is the significance of clonus in a patient with preeclampsia?

a) It indicates improved neurological function.
b) It is a normal finding in late pregnancy.
c) It suggests the resolution of hypertension.
d) It is a sign of worsening neurological irritability and potential seizure activity.

Answer 80

d) It is a sign of worsening neurological irritability and potential seizure activity.

Rationale: Clonus is an abnormal neurological finding in preeclampsia, indicating increased neuromuscular irritability and a heightened risk of seizures, necessitating prompt intervention.

Question 81

Which of the following is a major complication of preeclampsia characterized by tonic-clonic or focal seizure activity?

a) Pulmonary edema
b) Eclampsia
c) Abruptio placentae
d) Cerebrovascular accident

Answer 81

b) Eclampsia

Rationale: Eclampsia is a severe complication of preeclampsia involving the onset of tonic-clonic or focal seizures, indicating a critical escalation of the disease.

Question 82

Which of the following complications of preeclampsia is most directly linked to severe hypertension?

a) Hemorrhagic cerebrovascular accident
b) Fetal growth restriction
c) Hepatic hematoma
d) Disseminated intravascular coagulation (DIC)

Answer 82

a) Hemorrhagic cerebrovascular accident

Rationale: Severe hypertension in preeclampsia can result in a cerebrovascular accident (stroke) due to hemorrhage caused by high blood pressure.

Question 83

Which complication of preeclampsia is characterized by a life-threatening rupture or hematoma of the liver?

a) Disseminated intravascular coagulation (DIC)
b) Pulmonary edema
c) Hepatic rupture
d) Acute renal failure

Answer 83

c) Hepatic rupture

Rationale: Hepatic rupture or hematoma is a rare but catastrophic complication of preeclampsia, often associated with severe preeclampsia or HELLP syndrome.

Question 84

Which of the following describes disseminated intravascular coagulation (DIC) as a complication of preeclampsia?

a) A condition where blood clotting is limited to the placenta.

b) A bleeding disorder caused by widespread activation of the clotting cascade, leading to hemorrhage.

c) A pulmonary complication characterized by fluid in the alveoli.

d) A condition where the fetus develops severe anemia.

Answer 84

b) A bleeding disorder caused by widespread activation of the clotting cascade, leading to hemorrhage.

Rationale: DIC is a serious complication of preeclampsia involving the widespread activation of clotting mechanisms, resulting in both clot formation and increased risk of hemorrhage due to depletion of clotting factors.

Question 85

What is the definitive cure for preeclampsia?

a) Administering antihypertensive medication
b)Administering corticosteroids to mature the fetal lungs
c) Placing the patient on bedrest until symptoms resolve
d) Delivery of the fetus and placenta

Answer 85

d) Delivery of the fetus and placenta

Rationale: The only definitive cure for preeclampsia is the delivery of the fetus and placenta, as the condition is caused by abnormalities in placental function.

Question 86

What is the purpose of administering antenatal steroids such as betamethasone to a preeclamptic patient with a fetus under 36 weeks gestation?

a) To reduce maternal blood pressure

b) To reduce placental insufficiency

c) To prevent eclampsia

d) To enhance fetal lung maturity

Answer 86

d) To enhance fetal lung maturity

Rationale: Antenatal steroids like betamethasone are given to improve fetal lung development and reduce respiratory distress syndrome risk in preterm infants.

Question 87

What is the primary goal of biweekly nonstress tests (NSTs) for patients with preeclampsia?

a) To detect fetal hypoxia or distress
b) To monitor maternal blood pressure
c) To track fetal growth patterns
d) To monitor maternal uterine activity

Answer 87

a) To detect fetal hypoxia or distress

Rationale: Biweekly NSTs are performed starting at 28 weeks to monitor for signs of fetal hypoxia or distress, which can occur due to placental insufficiency in preeclampsia.

Question 88

Which management strategy is appropriate for mild preeclampsia managed on an outpatient basis?

a) Daily Doppler ultrasounds
b) Antihypertensive medication with bedrest
c) Serial blood pressure monitoring and growth ultrasounds
d) Immediate induction of labor

Answer 88

c) Serial blood pressure monitoring and growth ultrasounds

Rationale: Mild preeclampsia can often be managed on an outpatient basis with close monitoring of maternal blood pressure and fetal growth to ensure maternal and fetal well-being.

Question 89

Which blood pressure reading is indicative of severe preeclampsia?

a) SBP >140 or DBP >90, confirmed after 4 hours
b) SBP >160 or DBP >110, rechecked in 15 minutes
c) SBP >150 or DBP >100, confirmed after 2 hours
d) SBP >120 or DBP >80, persistent for 24 hours

Answer 89

b) SBP >160 or DBP >110, rechecked in 15 minutes

Rationale: Severe preeclampsia is defined by a systolic blood pressure >160 or diastolic >110 that remains elevated after 15 minutes, requiring immediate notification of the provider.

Question 90

What renal finding is consistent with severe preeclampsia?

a) Creatinine <1.0 mg/dL and urine output >50 mL/hr
b) Creatinine >1.1 mg/dL or urine output <30 mL/hr for 2 hours
c) Decreased urine protein and stable creatinine levels
d) Urine output >30 mL/hr for 4 consecutive hours

Answer 90

b) Creatinine >1.1 mg/dL or urine output <30 mL/hr for 2 hours

Rationale: Severe preeclampsia is associated with renal impairment, evidenced by creatinine levels >1.1 mg/dL or urine output <30 mL/hr over 2 hours.

Question 91

Which symptom requires immediate attention in a patient with severe preeclampsia?

a) Mild headaches relieved with acetaminophen
b) Intermittent nausea and vomiting
c) Severe, persistent epigastric or RUQ pain unrelieved by medication
d) Weight gain of 1 pound in 24 hours

Answer 91

c) Severe, persistent epigastric or RUQ pain unrelieved by medication

Rationale: Severe, persistent epigastric or right upper quadrant pain is a serious sign of severe preeclampsia, possibly indicating liver involvement or impending HELLP syndrome.

Question 92

What laboratory findings are consistent with severe preeclampsia?

a) Thrombocytopenia and elevated AST/ALT

b) Hemoglobin >15 g/dL and normal platelet count

c) Decreased LDH and stable liver function tests

d) Platelet count >150,000 and normal ALT

Answer 92

a) Thrombocytopenia and elevated AST/ALT

Rationale: Thrombocytopenia (platelet count <100,000) and elevated liver enzymes (AST/ALT) are significant findings in severe preeclampsia, indicating hepatic and hematologic dysfunction.

Question 93

Which nursing action is most appropriate when a patient with severe preeclampsia exhibits a blood pressure of 165/112 mmHg?

a) Recheck the blood pressure in 4 hours.

b) Administer oral antihypertensive medication and recheck in 15 minutes.

c) Recheck the blood pressure in 15 minutes and notify the provider immediately if still elevated.

d) Recommend immediate induction of labor.

Answer 93

c) Recheck the blood pressure in 15 minutes and notify the provider immediately if still elevated.

Rationale: Blood pressure >160/110 requires rechecking within 15 minutes and immediate provider notification if it remains elevated to prevent complications such as eclampsia or stroke.

Question 94

What is the primary purpose of initiating magnesium sulfate in preeclampsia with severe features?

a) To lower blood pressure
b) To prevent seizures
c) To manage severe pain
d) To stabilize fetal heart rate

Answer 94

b) To prevent seizures

Rationale: Magnesium sulfate is the drug of choice for seizure prophylaxis in preeclampsia with severe features, reducing the risk of progression to eclampsia.

Question 95

Which precaution is essential to implement for a patient with preeclampsia with severe features?

a) Fall precautions
b) Fluid restriction precautions
c) Isolation precautions
d) Seizure precautions

Answer 95

d) Seizure precautions

Rationale: Seizure precautions are critical for patients with severe preeclampsia, as they are at increased risk of eclampsia. These include maintaining a quiet environment, ensuring airway equipment is readily available, and monitoring for signs of magnesium toxicity.

Question 96

What is the primary characteristic of eclampsia?

a) Onset of coma or seizure in women with preeclampsia

b) Onset of hypertension and proteinuria in pregnancy

c) Severe swelling of the legs and face

d) Increased fetal heart rate and decreased fetal movement

Answer 96

a) Onset of coma or seizure in women with preeclampsia

Rationale: Eclampsia is defined by the onset of seizures or coma in women with preeclampsia, often leading to serious maternal and fetal complications.

Question 97

Which of the following are common premonitory signs of eclampsia? (Select all that apply)

a) Persistent headache
b) Elevated blood pressure alone
c) Blurred vision
d) Epigastric or right upper quadrant (RUQ) pain
e) Decreased fetal movement

Answer 97

a) Persistent headache
b) Elevated blood pressure alone
c) Blurred vision
d) Epigastric or right upper quadrant (RUQ) pain

Rationale: Common premonitory signs of eclampsia include persistent headache, blurred vision, epigastric or RUQ pain, and elevated blood pressure. Altered mental status may also be a warning sign.

Question 98

What is the relationship between eclampsia and preeclampsia?

a) Eclampsia occurs in women without a history of preeclampsia.
b) Eclampsia is a complication of preeclampsia involving seizures or coma.
c) Eclampsia is unrelated to preeclampsia but can occur in any pregnancy.
d) Eclampsia is diagnosed before preeclampsia in some cases.

Answer 98

b) Eclampsia is a complication of preeclampsia involving seizures or coma.

Rationale: Eclampsia is a severe complication of preeclampsia that involves the onset of seizures or coma in a woman with preeclampsia.

Question 99

Why is elevated blood pressure alone a concerning sign in the context of preeclampsia?

a) It is a sign of dehydration in the mother.

b) It is the only indicator of fetal distress.

c) It can be an early sign of eclampsia, especially when accompanied by other symptoms.

d) It is generally not concerning unless accompanied by proteinuria.

Answer 99

c) It can be an early sign of eclampsia, especially when accompanied by other symptoms.

Rationale: Elevated blood pressure, particularly in women with preeclampsia, can be an early warning sign of eclampsia when accompanied by symptoms such as headache, visual changes, and RUQ pain.

Question 100

Which of the following is a risk factor for the development of eclampsia?

a) History of gestational diabetes

b) No previous history of preeclampsia

c) Previous history of preeclampsia

d) Maternal age over 40 without comorbid conditions

Answer 100

c) Previous history of preeclampsia

Rationale: Women who have had preeclampsia in a previous pregnancy are at higher risk of developing eclampsia in subsequent pregnancies.

Question 101

What is the first priority intervention during an eclamptic seizure?

a) Administer magnesium sulfate

b) Maintain the airway

c) Call for help

d) Prepare for an immediate cesarean section

Answer 101

b) Maintain the airway

Rationale: Maintaining the airway is the first priority during an eclamptic seizure to ensure oxygenation and prevent aspiration.

Question 102

What is the expected effect on fetal heart rate (FHR) during an eclamptic seizure?

a) Accelerations in FHR
b) No change in FHR
c) Decrease in baseline FHR
d) Prolonged decelerations in FHR

Answer 102

d) Prolonged decelerations in FHR

Rationale: During an eclamptic seizure, prolonged decelerations in fetal heart rate are common, often due to uterine hypertonicity and reduced placental perfusion.

Question 103

What should be avoided when performing a cesarean section on a patient experiencing eclampsia?

a) Immediate delivery of the fetus without stabilization
b) Administering magnesium sulfate
c) Monitoring the fetal heart rate
d) Placing the patient in a supine position

Answer 103

a) Immediate delivery of the fetus without stabilization

Rationale: A crash cesarean section without prior stabilization can be harmful. The patient must first be stabilized before delivery to avoid complications like maternal cardiovascular collapse.

Question 104

Which of the following differentiates a headache in preeclampsia with severe features from a headache in mild preeclampsia?

a) The presence of blurred vision with the headache

b) A headache relieved by Tylenol

c) A headache unrelieved by Tylenol

d) A headache accompanied by proteinuria

Answer 104

c) A headache unrelieved by Tylenol

Rationale: A headache unrelieved by Tylenol is a hallmark symptom of preeclampsia with severe features, indicating possible cerebral involvement.

Question 105

When is cesarean delivery recommended for a patient with preeclampsia?

a) In all cases of preeclampsia

b) Only if the patient has had an eclamptic seizure or is unstable

c) At 35 weeks for mild preeclampsia

d) Only when labor has not progressed within 12 hours

Answer 105

b) Only if the patient has had an eclamptic seizure or is unstable

Rationale: Vaginal delivery is preferred in preeclampsia unless the patient has experienced an eclamptic seizure or is otherwise unstable, in which case cesarean delivery is indicated.

Question 106

Which of the following is a characteristic feature of eclampsia compared to preeclampsia?

a) Persistent epigastric or RUQ pain
b) Seizures or coma
c) Pulmonary edema
d) Thrombocytopenia

Answer 106

b) Seizures or coma

Rationale: Eclampsia is defined by the onset of seizures or coma, which distinguishes it from preeclampsia with or without severe features.

Question 107

What blood pressure readings indicate preeclampsia with severe features?

a) >140/90 mm Hg after 20 weeks gestation
b) ≥160/110 mm Hg on two occasions at least 6 hours apart while on bed rest
c) >160/110 mm Hg for one reading
d) SBP >130 or DBP >80 on two occasions

Answer 107

b) ≥160/110 mm Hg on two occasions at least 6 hours apart while on bed rest

Rationale: Blood pressure readings of ≥160/110 mm Hg on two occasions 6 hours apart are indicative of preeclampsia with severe features.

Question 108

Which signs or symptoms are associated with preeclampsia with severe features? (Select all that apply)

a) Headache
b) Oliguria
c) HELLP syndrome
d) Hyperreflexia
e) Seizures

Answer 108

a) Headache
b) Oliguria
c) HELLP syndrome
d) Hyperreflexia

Rationale: Severe features of preeclampsia include headache, oliguria, HELLP syndrome, and hyperreflexia. Seizures are specific to eclampsia.

Question 109

What symptom is common to both preeclampsia with severe features and eclampsia?

a) Pulmonary edema
b) Seizures
c) Hyperreflexia
d) HELLP syndrome

Answer 109

c) Hyperreflexia

Rationale: Hyperreflexia is common in both preeclampsia with severe features and eclampsia and indicates heightened neuromuscular irritability.

Question 110

Which of the following symptoms would require immediate evaluation for progression from preeclampsia to eclampsia?

a) Persistent headache
b) Platelet count of 150,000/mm³
c) Blurred vision with new-onset seizure activity
d) SBP >140/90 mm Hg

Answer 110

c) Blurred vision with new-onset seizure activity

Rationale: Seizure activity marks the transition from preeclampsia to eclampsia and requires immediate evaluation and management.

Question 111

Which of the following symptoms are specific to eclampsia compared to preeclampsia with severe features? (Select all that apply)

a) Seizures
b) Hyperreflexia
c) Coma
d) Persistent RUQ pain
e) Pulmonary edema

Answer 111

a) Seizures
c) Coma

Rationale: Seizures and coma are defining features of eclampsia, while hyperreflexia, RUQ pain, and pulmonary edema may also be present in preeclampsia with severe features.

Question 112

What does HELLP syndrome stand for?

A. Hypertension, Elevated liver enzymes, Low platelet count

B. Hypoglycemia, Elevated liver enzymes, Low platelet count

C. Hyperlipidemia, Elevated liver enzymes, Low platelet count

D. Hemolysis, Elevated liver enzymes, Low platelet count

Answer 112

D. Hemolysis, Elevated liver enzymes, Low platelet count

Question 113

What is the essential phenomenon in the development of HELLP syndrome?

A. Excessive weight gain due to inadequate maternal immune tolerance

B. Abnormal trophoblastic invasion due to inadequate maternal immune tolerance

C. High blood glucose levels due to inadequate maternal immune tolerance

D. Increased dietary salt intake due to inadequate maternal immune tolerance

Answer 113

B. Abnormal trophoblastic invasion due to inadequate maternal immune tolerance

Rationale: The essential phenomenon in the development of HELLP syndrome is abnormal trophoblastic invasion due to inadequate maternal immune tolerance.

Question 114

Which complications are women with HELLP syndrome at increased risk for? (Select all that apply)

A. Cerebral hemorrhage
B. Retinal detachment
C. Hematoma/liver rupture
D. Deep vein thrombosis (DVT)
E. Disseminated intravascular coagulation (DIC)

Answer 114

A. Cerebral hemorrhage
B. Retinal detachment
C. Hematoma/liver rupture
E. Disseminated intravascular coagulation (DIC)

Rationale: Women with HELLP syndrome are at increased risk for complications such as cerebral hemorrhage, retinal detachment, hematoma/liver rupture, and DIC.

Question 115

When does HELLP syndrome typically develop in pregnant women?

A. First trimester
B. Second trimester
C. Third trimester
D. Postpartum period only

Answer 115

C. Third trimester

Rationale: HELLP syndrome generally develops during the third trimester, although it may develop within 48 hours after delivery.

Question 116

What is a characteristic feature of the onset of HELLP syndrome?

A. Slow and progressive onset
B. Rapid onset with vague symptoms
C. Gradual onset with specific symptoms
D. Delayed onset after delivery

Answer 116

B. Rapid onset with vague symptoms

Rationale: HELLP syndrome typically has a rapid onset, and women often present with vague symptoms.

Question 117

What are the mainstays of treatment for HELLP syndrome? (Select all that apply)

A. Lowering high blood pressure with rapid-acting antihypertensive agents

B. Prevention of convulsions or further seizures with magnesium sulfate

C. Use of steroids for fetal lung maturity if necessary

D. Increasing dietary protein intake

E. Birth of the infant and placenta

Answer 117

A. Lowering high blood pressure with rapid-acting antihypertensive agents

B. Prevention of convulsions or further seizures with magnesium sulfate

C. Use of steroids for fetal lung maturity if necessary

E. Birth of the infant and placenta

Question 118

Why might birth be delayed up to 96 hours in the management of HELLP syndrome?

A. To reduce maternal weight to stimulate lung maturation in the preterm fetus

B. To allow time for betamethasone or dexamethasone to stimulate lung maturation in the preterm fetus

C. To increase maternal blood pressure to stimulate lung maturation in the preterm fetus

D. To monitor maternal glucose levels to stimulate lung maturation in the preterm fetus

Answer 118

B. To allow time for betamethasone or dexamethasone to stimulate lung maturation in the preterm fetus

Rationale: Birth may be delayed up to 96 hours to allow time for betamethasone or dexamethasone to stimulate lung maturation in the preterm fetus.

Question 119

What additional treatment is indicated for correcting the coagulopathies that accompany HELLP syndrome?

A. Blood component therapy
B. Administration of diuretics
C. Increased fluid intake
D. Increased salt intake

Answer 119

A. Blood component therapy

Rationale: Blood component therapy, such as the administration of fresh-frozen plasma, packed red blood cells, or platelets, is indicated to address the coagulopathies that accompany HELLP syndrome.

Question 120

What common symptoms should nurses be alert for in a woman with HELLP syndrome? (Select all that apply)

A. Nausea (with or without vomiting)
B. Malaise
C. Epigastric or right upper quadrant pain
D. Headache
E. Changes in vision
F. Increased appetite

Answer 120

A. Nausea (with or without vomiting)
B. Malaise
C. Epigastric or right upper quadrant pain
D. Headache
E. Changes in vision

Rationale: Nurses should be alert for complaints of nausea (with or without vomiting), malaise, epigastric or right upper quadrant pain, headache, and changes in vision in a woman with HELLP syndrome. Increased appetite is not a typical symptom.

Question 121

Which laboratory test results are indicative of HELLP syndrome? (Select all that apply)

A. Low hematocrit not explained by any blood loss
B. Elevated LDH
C. Decreased AST and ALT
D. Elevated BUN
E. Elevated uric acid and creatinine levels
F. Low platelet count (less than 100,000 cells/mm³)

Answer 121

A. Low hematocrit not explained by any blood loss
B. Elevated LDH
D. Elevated BUN
E. Elevated uric acid and creatinine levels
F. Low platelet count (less than 100,000 cells/mm³)

Question 122

What specific laboratory findings suggest liver impairment in HELLP syndrome? (Select all that apply)

A. Elevated LDH
B. Elevated AST
C. Elevated ALT
D. Elevated bilirubin level
E. Low creatinine levels

Answer 122

A. Elevated LDH
B. Elevated AST
C. Elevated ALT
D. Elevated bilirubin level

Question 123

A pregnant client at 32 weeks presents with a persistent headache, epigastric pain, and visual disturbances. Laboratory results reveal: AST 85 U/L, ALT 90 U/L, and platelets 90,000/mm³. What is the most likely condition?

A. Gestational diabetes
B. HELLP syndrome
C. Hyperemesis gravidarum
D. Placenta previa

Answer 123

B. HELLP syndrome

Rationale: Elevated liver enzymes (AST/ALT), low platelets (<100,000), and clinical symptoms suggest HELLP syndrome, a severe preeclampsia complication.

Question 124

What nursing interventions are necessary for a patient on magnesium sulfate for preeclampsia? (Select all that apply)

A. Close monitoring of vital signs
B. Monitoring deep tendon reflexes (DTRs)
C. Assessing urine output
D. Encouraging high fluid intake

Answer 124

A. Close monitoring of vital signs
B. Monitoring deep tendon reflexes (DTRs)
C. Assessing urine output

Rationale: Nursing interventions include close monitoring of vital signs, DTRs, and urine output to detect signs of magnesium toxicity and ensure patient safety.

Question 125

Which clinical sign is a key indicator of magnesium toxicity?

A. Hyperreflexia
B. Increased blood pressure
C. Hyperventilation
D. Hyporeflexia

Answer 125

D. Hyporeflexia

Rationale: Hyporeflexia or absent DTRs are key indicators of magnesium toxicity.

Question 126

What are the signs and symptoms of magnesium toxicity? (Select all that apply)

A. Hyporeflexia or absence of DTRs
B. Respiratory rate less than 12 breaths per minute
C. Decreased urine output (less than 30 mL/hr)
D. Increased heart rate

Answer 126

A. Hyporeflexia or absence of DTRs
B. Respiratory rate less than 12 breaths per minute
C. Decreased urine output (less than 30 mL/hr)

Question 127

What should be monitored closely to avoid magnesium toxicity? (Select all that apply)

A. Serum magnesium levels
B. Respiratory rate
C. Blood glucose levels
D. Urine output

Answer 127

A. Serum magnesium levels
B. Respiratory rate
D. Urine output

Question 128

A nurse is caring for a woman in preterm labor who is receiving magnesium sulfate therapy. Which of the following should the nurse prioritize in monitoring the client?

A) Maternal blood pressure
B) Fetal heart rate variability
C) Maternal respiratory effort and deep tendon reflexes
D) Uterine contraction frequency

Answer 128

C) Maternal respiratory effort and deep tendon reflexes

Rationale: Magnesium sulfate requires frequent monitoring of maternal respiratory effort and deep tendon reflexes for early signs of overdose.

Question 129

A nurse is preparing to administer magnesium sulfate to a client in preterm labor. What is the primary purpose of this medication?

A) To reduce uterine irritability and delay labor
B) To enhance fetal lung maturity
C) To prevent maternal hypotension
D) To promote fetal heart rate stability

Answer 129

A) To reduce uterine irritability and delay labor

Rationale: Magnesium sulfate is used as a tocolytic agent to reduce uterine irritability and delay labor.

Question 130

A nurse is caring for a client who is receiving magnesium sulfate for preterm labor. Which of the following findings is indicative of magnesium sulfate toxicity?

A) Deep tendon reflexes of 2+
B) Respiratory rate of 11 breaths per minute
C) Serum magnesium level of 5 mg/dL
D) Urine output of 100 mL per hour

Answer 130

B) Respiratory rate of 11 breaths per minute

Rationale: A respiratory rate of less than 12 breaths per minute is a sign of magnesium sulfate toxicity, requiring immediate intervention.

Question 131

A nurse is assessing a client receiving magnesium sulfate and suspects magnesium toxicity. Which of the following signs would most likely indicate magnesium toxicity?

A) Hyperactive reflexes and hypotension
B) Increased urinary output and hypotension
C) Elevated heart rate and hypotension
D) Respiratory depression and hypotension

Answer 131

D) Respiratory depression and hypotension

Rationale: Rationale: Respiratory depression, hypotension, and other signs of neuromuscular impairment are common symptoms of magnesium toxicity.

Question 132

A client receiving magnesium sulfate is exhibiting signs of magnesium toxicity. What is the nurse’s next step after stopping the infusion and administering calcium gluconate?

A) Obtain the client’s vital signs
B) Increase the client’s intravenous fluids
C) Administer an additional dose of magnesium sulfate
D) Prepare the client for an immediate cesarean section

Answer 132

A) Obtain the client’s vital signs

Rationale: After stopping the infusion and administering calcium gluconate, the nurse should obtain vital signs to assess the client’s status and response to the treatment.

Question 133

A nurse is administering magnesium sulfate to a client in preterm labor. Which of the following is the primary reason for administering magnesium sulfate in this scenario?

A) To relieve uterine pain and discomfort
B) To inhibit uterine contractions and delay preterm labor
C) To prevent the development of preeclampsia
D) To promote fetal lung maturity

Answer 133

B) To inhibit uterine contractions and delay preterm labor

Rationale: Magnesium sulfate is used to inhibit uterine contractions and delay preterm labor, providing additional time for fetal lung maturation and other interventions.

Question 134

A nurse is caring for a client receiving magnesium sulfate for preterm labor. Which of the following is the most common maternal side effect of magnesium sulfate therapy?

A) Hyperkalemia
B) Tachycardia
C) Nausea and vomiting
D) Hypotension

Answer 134

C) Nausea and vomiting

Rationale: Nausea and vomiting are common side effects of magnesium sulfate therapy, along with other symptoms such as weakness and drowsiness.

Question 135

A client in preterm labor is receiving magnesium sulfate for contraction inhibition. The nurse notes a decrease in the fetal heart rate variability. What is the nurse’s priority action?

A) Increase the magnesium sulfate dose
B) Notify the healthcare provider
C) Administer oxygen via face mask to the client
D) Discontinue magnesium sulfate and assess for signs of toxicity

Answer 135

D) Discontinue magnesium sulfate and assess for signs of toxicity

Rationale: A decrease in fetal heart rate variability can be a sign of magnesium toxicity. The nurse should discontinue the magnesium sulfate and assess for signs of toxicity in the mother.

Question 136

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication?

A) Urinary output of 20 mL per hour

B) Respiratory rate of 10 breaths/minute

C) Deep tendons reflexes 2+

D) Difficulty in arousing

Answer 136

C) Deep tendons reflexes 2+

Question 137

A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which of the following would the lead the nurse to suspect that the client is having an adverse effect associated with this drug?

A) Gastrointestinal bleeding

B) Blurred vision

C) Tachycardia

D) Sweating

Answer 137

C) Tachycardia

Question 138

After reviewing a clients history, which factor would the nurse identify as placing her at risk for gestational hypertension?

A) Mother had gestational hypertension during pregnancy.

B) Client has a twin sister.

C) Sister-in-law had gestational hypertension.

D) This is the clients second pregnancy.

Answer 138

A) Mother had gestational hypertension during pregnancy.

Question 139

The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome?

A) Hyperglycemia

B) Elevated platelet count

C) Leukocytosis

D) Elevated liver enzymes

Answer 139

D) Elevated liver enzymes

Question 140

Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?

A) Calcium gluconate

B) Potassium chloride

C) Ferrous sulfate

D) Calcium carbonate

Answer 140

A) Calcium gluconate

Question 141

A nurse is assessing a pregnant woman with gestational hypertension. Which of the following would lead the nurse to suspect that the client has developed severe preeclampsia?

A) Urine protein 300 mg/24 hours

B) Blood pressure 150/96 mm Hg

C) Mild facial edema

D) Hyperreflexia

Answer 141

D) Hyperreflexia

Question 142

A woman with gestational hypertension experiences a seizure. Which of the following would be the priority?

A) Fluid replacement

B) Oxygenation

C) Control of hypertension

D) Delivery of the fetus

Answer 142

B) Oxygenation