MIDTERM CH 19: Nursing Management of Pregnancy at Risk: Pregnancy-Related Complications Flashcards
1
Q
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
A
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.
2
Q
Which of the following findings would differentiate gestational hypertension from preeclampsia?
a. Elevated liver enzymes
b. Proteinuria
c. Hypertension
d. Hyperreflexia
A
b. Proteinuria
Rationale: Preeclampsia involves both hypertension and proteinuria, while gestational hypertension is diagnosed in the absence of proteinuria.
3
Q
At what point postpartum does gestational hypertension typically resolve?
a. 6 weeks
b. 8 weeks
c. 12 weeks
d. 20 weeks
A
c. 12 weeks
Rationale: Gestational hypertension typically resolves by 12 weeks postpartum.
4
Q
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
A
a. Chronic hypertension
Rationale: Hypertension present before 20 weeks of gestation or prior to pregnancy is classified as chronic hypertension.
5
Q
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.”
A
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.
6
Q
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
A
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.
7
Q
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
A
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.
8
Q
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
A
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.
9
Q
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
A
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.
10
Q
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
A
B. At or after 37 weeks
Rationale: Gestational hypertension most commonly occurs at or after 37 weeks of gestation.
11
Q
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
A
D. Multiparous women
Rationale: Multiparous women have a higher incidence of gestational hypertension, ranging from 6% to 17%.
12
Q
What potential complication should women with gestational hypertension be monitored for?
A. Diabetes
B. Anemia
C. Preeclampsia
D. Preterm labor
A
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.
13
Q
What is the most frequent cause of hypertension during pregnancy?
A. Chronic hypertension
B. Pre-existing hypertension
C. Preeclampsia
D. Gestational hypertension
A
D. Gestational hypertension
Rationale: The most frequent cause of hypertension during pregnancy is gestational hypertension.
14
Q
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
A
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.
15
Q
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
A
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.
16
Q
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
A
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.
17
Q
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
A
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.
18
Q
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
A
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.
19
Q
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
A
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.
20
Q
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
A
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.
21
Q
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
A
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.
22
Q
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
A
C. It is diagnosed before 20 weeks’ gestation
Rationale: Chronic hypertension is diagnosed before 20 weeks’ gestation and is often pre-existing before pregnancy.
23
Q
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
A
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.
24
Q
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
A
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.
25
What is a potential risk for patients with chronic hypertension during pregnancy?
A. Placental abruption
B. Gestational diabetes
C. Anemia
D. Polyhydramnios
A. Placental abruption
Rationale: Patients with chronic hypertension are at risk for placental abruption, which is when the placenta detaches from the uterus.
26
What is the impact of chronic hypertension on perinatal mortality?
A. No impact
B. Decreases mortality
C. Unpredictable impact
D. Increases mortality
D. Increases mortality
Rationale: Chronic hypertension is associated with increased perinatal mortality (fetal death).
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
C. High risk
Rationale: Patients with chronic hypertension are at high risk for intrauterine fetal demise (IUFD).
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)
D. Small for Gestational Age (SGA)
Rationale: Chronic hypertension increases the risk of the fetus being Small for Gestational Age (SGA).
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
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.
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
a) Renal failure
Rationale: Postpartum complications from chronic hypertension can include renal failure, in addition to other cardiovascular complications.
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.
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.
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)
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.
33
What is a potential postpartum complication for a woman with chronic hypertension?
a) Pulmonary edema
b) Anemia
c) Hyperthyroidism
d) Gestational diabetes
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.
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
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.
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.
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.
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
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.
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
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.
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
C. They can cause birth defects
Rationale: ACE inhibitors and ARBs need to be switched in pregnant patients because they can cause birth defects.
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
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.
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
B. Hydralazine, Labetalol, Nifedipine
Rationale: Hydralazine, Labetalol, and Nifedipine are commonly used to manage chronic hypertension in pregnancy.
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
all of the choices are correct
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
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.
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
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.
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.
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).
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
B. Cardiovascular system
C. Hepatic system
D. Renal system
E. Central nervous system
Rationale: Preeclampsia targets the cardiovascular, hepatic, renal, and central nervous systems.
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
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.
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
B. After 20 weeks gestation
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
C. Second half of pregnancy
Rationale: Preeclampsia most commonly manifests in the second half of pregnancy.
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
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.
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
b) Hypertension and proteinuria after 20 weeks gestation
Rationale: Preeclampsia is characterized by the development of hypertension and proteinuria after 20 weeks gestation.
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
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.
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
A. Exact cause unknown
Rationale: The exact cause of preeclampsia is still unknown, despite extensive research.
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
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.
54
What is the definitive cure for preeclampsia/eclampsia?
A. Antihypertensive medication
B. Bed rest
C. Low-sodium diet
D. Delivery of the placenta
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.
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
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.
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
all of the choices are correct
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
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.
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
C. 37 weeks
Rationale: For non-severe hypertensive disorders in pregnancy, delivery is recommended at 37 weeks.
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
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.
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
B. Lateral recumbent position
Rationale: The lateral recumbent position is recommended to improve uteroplacental blood flow, reduce blood pressure, and promote diuresis.
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
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.
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
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.
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
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.
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.
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.
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.
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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."
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.
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.
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.
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
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.
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
c) Elevated lactate dehydrogenase (LDH)
Rationale: Elevated LDH levels indicate tissue damage or hemolysis, which can signify worsening preeclampsia or progression toward HELLP syndrome.
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.
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.
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
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.
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)
a) Hemorrhagic cerebrovascular accident
Rationale: Severe hypertension in preeclampsia can result in a cerebrovascular accident (stroke) due to hemorrhage caused by high blood pressure.
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
c) Hepatic rupture
Rationale: Hepatic rupture or hematoma is a rare but catastrophic complication of preeclampsia, often associated with severe preeclampsia or HELLP syndrome.
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.
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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.
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.
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
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.
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
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.
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
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.
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
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.
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.
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.
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.
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.
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
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.
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
b) Maintain the airway
Rationale: Maintaining the airway is the first priority during an eclamptic seizure to ensure oxygenation and prevent aspiration.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
109
What symptom is common to both preeclampsia with severe features and eclampsia?
a) Pulmonary edema
b) Seizures
c) Hyperreflexia
d) HELLP syndrome
c) Hyperreflexia
Rationale: Hyperreflexia is common in both preeclampsia with severe features and eclampsia and indicates heightened neuromuscular irritability.
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
c) Blurred vision with new-onset seizure activity
Rationale: Seizure activity marks the transition from preeclampsia to eclampsia and requires immediate evaluation and management.
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
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.
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
D. Hemolysis, Elevated liver enzymes, Low platelet count
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
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.
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)
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.
115
When does HELLP syndrome typically develop in pregnant women?
A. First trimester
B. Second trimester
C. Third trimester
D. Postpartum period only
C. Third trimester
Rationale: HELLP syndrome generally develops during the third trimester, although it may develop within 48 hours after delivery.
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
B. Rapid onset with vague symptoms
Rationale: HELLP syndrome typically has a rapid onset, and women often present with vague symptoms.
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
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
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
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.
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
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.
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
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.
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)
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)
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
A. Elevated LDH
B. Elevated AST
C. Elevated ALT
D. Elevated bilirubin level
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
B. HELLP syndrome
Rationale: Elevated liver enzymes (AST/ALT), low platelets (<100,000), and clinical symptoms suggest HELLP syndrome, a severe preeclampsia complication.
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
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.
125
Which clinical sign is a key indicator of magnesium toxicity?
A. Hyperreflexia
B. Increased blood pressure
C. Hyperventilation
D. Hyporeflexia
D. Hyporeflexia
Rationale: Hyporeflexia or absent DTRs are key indicators of magnesium toxicity.
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
A. Hyporeflexia or absence of DTRs
B. Respiratory rate less than 12 breaths per minute
C. Decreased urine output (less than 30 mL/hr)
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
A. Serum magnesium levels
B. Respiratory rate
D. Urine output
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
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.
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
A) To reduce uterine irritability and delay labor
Rationale: Magnesium sulfate is used as a tocolytic agent to reduce uterine irritability and delay labor.
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
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.
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
D) Respiratory depression and hypotension
Rationale: Rationale: Respiratory depression, hypotension, and other signs of neuromuscular impairment are common symptoms of magnesium toxicity.
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
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.
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
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.
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
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.
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
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.
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
C) Deep tendons reflexes 2+
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
C) Tachycardia
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.
A) Mother had gestational hypertension during pregnancy.
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
D) Elevated liver enzymes
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
A) Calcium gluconate
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
D) Hyperreflexia
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
B) Oxygenation
143
