Quiz 2 Flashcards
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
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.
Which of the following findings would differentiate gestational hypertension from preeclampsia?
a. Elevated liver enzymes
b. Proteinuria
c. Hypertension
d. Hyperreflexia
b. Proteinuria
Rationale: Preeclampsia involves both hypertension and proteinuria, while gestational hypertension is diagnosed in the absence of proteinuria.
At what point postpartum does gestational hypertension typically resolve?
a. 6 weeks
b. 8 weeks
c. 12 weeks
d. 20 weeks
c. 12 weeks
Rationale: Gestational hypertension typically resolves by 12 weeks postpartum.
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. Chronic hypertension
Rationale: Hypertension present before 20 weeks of gestation or prior to pregnancy is classified as chronic hypertension.
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. “This condition is likely to resolve after delivery.”
Rationale: Gestational hypertension typically resolves after delivery, but it can progress to preeclampsia in some cases.
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
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.
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
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.
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
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.
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
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.
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
B. At or after 37 weeks
Rationale: Gestational hypertension most commonly occurs at or after 37 weeks of gestation.
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
D. Multiparous women
Rationale: Multiparous women have a higher incidence of gestational hypertension, ranging from 6% to 17%.
What potential complication should women with gestational hypertension be monitored for?
A. Diabetes
B. Anemia
C. Preeclampsia
D. Preterm labor
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.
What is the most frequent cause of hypertension during pregnancy?
A. Chronic hypertension
B. Pre-existing hypertension
C. Preeclampsia
D. Gestational hypertension
D. Gestational hypertension
Rationale: The most frequent cause of hypertension during pregnancy is gestational hypertension.
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
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.
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. 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.
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
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.
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
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.
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
C. It is diagnosed before 20 weeks’ gestation
Rationale: Chronic hypertension is diagnosed before 20 weeks’ gestation and is often pre-existing before pregnancy.
At what point in gestation does chronic hypertension typically occur?
A. After 20 weeks gestation
B. Prior to 20 weeks gestation
C. At birth
D. During labor
B. Prior to 20 weeks gestation
Rationale: Chronic hypertension is defined as occurring prior to 20 weeks gestation.
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
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.
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. 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.
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.
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).
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).
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).
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.
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.
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.
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.
What is a critical monitoring parameter for worsening chronic hypertension in pregnancy?
A. Laboratory values, symptoms, rising blood pressure, and fetal surveillance
B. Height and weight measurements
C. Fetal heart rate and movement, and oxygen saturation levels
D. Oxygen saturation levels, and height and weight measurements
A. Laboratory values, symptoms, rising blood pressure, and fetal surveillance
Rationale: Monitoring for worsening of chronic hypertension includes checking laboratory values, symptoms, rising blood pressure, and conducting fetal surveillance starting at 28 weeks, including growth ultrasounds.
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).
What distinguishes severe preeclampsia from mild preeclampsia?
A. Presence of headaches
B. Presence of maternal organ dysfunction
C. Absence of hypertension
D. Decreased fetal movement
B. Presence of maternal organ dysfunction
Rationale: Severe preeclampsia is distinguished by the presence of maternal organ dysfunction, which can impact the cardiovascular, hepatic, renal, and CNS systems.
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.
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.
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
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.
How is preeclampsia classified?
A. Preeclampsia with anemia or preeclampsia with diabetes
B. Preeclampsia with heart failure or preeclampsia with renal failure
C. Preeclampsia with infection or preeclampsia with edema
D. Preeclampsia alone or preeclampsia with severe features
D. Preeclampsia alone or preeclampsia with severe features
Rationale: Preeclampsia is classified into two categories: preeclampsia alone or preeclampsia with severe features.
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.
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.
Which fetal complications are associated with poor placental perfusion in preeclampsia? (Select all that apply)
A. Intrauterine growth restriction
B. Placental abruption
C. Persistent fetal hypoxia
D. Fetal acidosis
E. Polycythemia
A. Intrauterine growth restriction
B. Placental abruption
C. Persistent fetal hypoxia
D. Fetal acidosis
Rationale: Poor placental perfusion in preeclampsia is associated with intrauterine growth restriction (A), placental abruption (B), persistent fetal hypoxia (C), and fetal acidosis (D).
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.
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.
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.
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.
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
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.
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.
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.
What criteria determine the use of conservative strategies for preeclampsia without severe features?
A. Presence of severe hypertension
B. Signs of renal or hepatic dysfunction or coagulopathy
C. High sodium intake
D. Absence of signs of renal or hepatic dysfunction or coagulopathy
D. Absence of signs of renal or hepatic dysfunction or coagulopathy
Rationale: Conservative strategies are used if the woman exhibits no signs of renal or hepatic dysfunction or coagulopathy.
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.
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.
How often should a woman with preeclampsia without severe features monitor her blood pressure at home?
A. Once a week
B. Every 4 to 6 hours
C. Every 2 to 4 hours
D. Once a month
B. Every 4 to 6 hours
Rationale: She should monitor her blood pressure daily, every 4 to 6 hours while awake.
What dietary recommendation is given to a woman with mild preeclampsia?
A. Balanced, nutritional diet with no sodium restriction
B. High-sodium diet
C. Low-calorie diet
D. High-protein diet
A. Balanced, nutritional diet with no sodium restriction
Rationale: A balanced, nutritional diet with no sodium restriction is advised.
What is included in the current management of preeclampsia for high-risk women? (Select all that apply)
A. Preconception counseling
B. Prenatal aspirin therapy
C. Antenatal steroids (betamethasone) for women prior to 34 weeks’ gestation
D. Parenteral magnesium sulfate prophylaxis
E. Low-calorie diet
F. Follow-up of postpartum blood pressures
A. Preconception counseling
B. Prenatal aspirin therapy
C. Antenatal steroids (betamethasone) for women prior to 34 weeks’ gestation
D. Parenteral magnesium sulfate prophylaxis
F. Follow-up of postpartum blood pressures
Rationale: High-risk women with preeclampsia receive preconception counseling, prenatal aspirin therapy, antenatal steroids for women prior to 34 weeks’ gestation, parenteral magnesium sulfate prophylaxis, and follow-up of postpartum blood pressures.
Which symptoms signal preeclampsia with severe features?
A. Low blood pressure and headaches
B. High blood pressure (>160/110 mm Hg) and cerebral and visual symptoms
C. Decreased liver function and thrombocytopenia
D. Low blood pressure and proteinuria
B. High blood pressure (>160/110 mm Hg) and cerebral and visual symptoms
Rationale: Symptoms that signal preeclampsia with severe features include high blood pressure (>160/110 mm Hg), cerebral and visual symptoms, pulmonary edema, epigastric pain, impaired liver function, thrombocytopenia, and progressive renal insufficiency.
What is the antidote for magnesium sulfate overdose?
A. Vitamin K
B. Potassium chloride
C. Sodium bicarbonate
D. Calcium gluconate
D. Calcium gluconate
Rationale: Calcium gluconate (10 mL of a 10% solution injected IV over 3 minutes) is an effective antidote for magnesium sulfate overdose.
Why is a vaginal delivery preferred over a cesarean birth for women with preeclampsia with severe features?
A. Less risk of infection
B. Better maternal outcomes
C. Easier for the healthcare provider
D. Faster delivery process
B. Better maternal outcomes
Rationale: A vaginal delivery is preferred as it offers better maternal outcomes and poses less risk compared to a surgical birth.
What should a newborn whose mother received high doses of magnesium sulfate be monitored for?
A. Hyperactivity, hypotonia and increased muscle tone
B. Increased blood pressure, hypotonia and tachycardia
C. Hypercalcemia, hypotonia and hyperreflexia
D. Respiratory depression, hypocalcemia, and hypotonia
D. Respiratory depression, hypocalcemia, and hypotonia
Rationale: A newborn whose mother received high doses of magnesium sulfate should be monitored for respiratory depression, hypocalcemia, and hypotonia.
What is the focus of therapy for preeclampsia with severe features during labor?
A. Controlling hypertension and preventing seizures
B. Increasing maternal weight gain
C. Reducing maternal heart rate
D. Increasing dietary sodium intake
A. Controlling hypertension and preventing seizures
Rationale: The focus of therapy during labor is on controlling hypertension, preventing seizures, preventing long-term morbidity, and preventing maternal, fetal, or newborn death.
Which assessments are crucial for monitoring a woman with preeclampsia? (Select all that apply)
A. Pitting edema
B. Deep tendon reflexes (DTRs)
C. Clonus
D. Blood sugar levels
E. Blood pressure
A. Pitting edema
B. Deep tendon reflexes (DTRs)
C. Clonus
E. Blood pressure
Rationale: Crucial assessments for monitoring a woman with preeclampsia include pitting edema, deep tendon reflexes (DTRs), clonus, and blood pressure.
Which diagnostic tests are important in the management of preeclampsia? (Select all that apply)
A. Chemistry panel (LFTs, BUN, creatinine)
B. Elevated lactate dehydrogenase (LDH)
C. Complete blood count (CBC) and platelets
D. Blood glucose test
E. Uric acid level >5 mg/dL
A. Chemistry panel (LFTs, BUN, creatinine)
B. Elevated lactate dehydrogenase (LDH)
C. Complete blood count (CBC) and platelets
E. Uric acid level >5 mg/dL
Rationale: Important diagnostic tests in the management of preeclampsia include chemistry panel (LFTs, BUN, creatinine), elevated lactate dehydrogenase (LDH), complete blood count (CBC) and platelets, and uric acid level >5 mg/dL.
Why is monitoring for protein in urine significant in preeclampsia?
A. It indicates dehydration
B. It signals renal impairment
C. It shows normal kidney function
D. It indicates hyperglycemia
B. It signals renal impairment
Rationale: Monitoring for protein in urine is significant in preeclampsia because it signals renal impairment, which is a critical aspect of the condition.
Which subjective complaints should nurses assess for in clients with preeclampsia to detect disease progression? (Select all that apply)
A. Visual changes
B. Severe headaches
C. Unusual bleeding or bruising
D. Epigastric pain
E. Increased appetite
A. Visual changes
B. Severe headaches
C. Unusual bleeding or bruising
D. Epigastric pain
Rationale: Nurses should assess for subjective complaints such as visual changes, severe headaches, unusual bleeding or bruising, and epigastric pain to detect progression of preeclampsia.
What is the risk associated with the late detection of preeclampsia symptoms?
A. Severe gestational hypertension
B. Mild hypertension
C. Decreased maternal health
D. Reduced need for medical intervention
A. Severe gestational hypertension
Rationale: By the time symptoms are noticed, gestational hypertension can be severe, which underscores the importance of regular monitoring and assessment.
What are some risk factors for preeclampsia? (Select all that apply)
A. Primigravida status
B. Chromosomal abnormalities
C. History of diabetes
D. African American ethnicity
E. Age between 20 and 35
A. Primigravida status
B. Chromosomal abnormalities
C. History of diabetes
D. African American ethnicity
Rationale: Risk factors for preeclampsia include primigravida status, chromosomal abnormalities, history of diabetes, African American ethnicity, among others. Age younger than 20 or older than 35 is also a risk factor, not age between 20 and 35.
What nutritional aspects should be assessed in a woman at risk for preeclampsia? (Select all that apply)
A. Usual intake of protein
B. Daily calcium intake
C. Amount of carbohydrates consumed
D. Total daily calories
E. Fluid intake
A. Usual intake of protein
B. Daily calcium intake
D. Total daily calories
E. Fluid intake
Rationale: A nutritional assessment for a woman at risk for preeclampsia should include her usual intake of protein, daily calcium intake, total daily calories, and fluid intake.
Which position yields the highest blood pressure reading during prenatal visits?
A. Supine position
B. Sitting position
C. Prone position
D. Side-lying position
B. Sitting position
What laboratory tests are typically performed to evaluate a woman with preeclampsia? (Select all that apply)
A. Complete blood count (CBC)
B. Serum electrolytes
C. Blood urea nitrogen (BUN)
D. Serum glucose levels
E. Creatinine
F. Hepatic enzyme levels
A. Complete blood count (CBC)
B. Serum electrolytes
C. Blood urea nitrogen (BUN)
E. Creatinine
F. Hepatic enzyme levels
Rationale: Laboratory tests typically performed to evaluate a woman with preeclampsia include a CBC, serum electrolytes, BUN, creatinine, and hepatic enzyme levels. Serum glucose levels are not specifically mentioned in the provided text.
What is the next step if protein levels of 1 to 2+ or greater are found in a urine specimen of a woman with preeclampsia?
A. No further testing is needed
B. Immediate delivery of the fetus
C. 24-hour urine collection
D. Administration of diuretics
C. 24-hour urine collection
Rationale: If protein levels of 1 to 2+ or greater are found in a urine specimen, a 24-hour urine collection is completed to further assess the extent of proteinuria.
What blood pressure measurement confirms a diagnosis of preeclampsia?
A. Systolic BP > 130 or Diastolic BP > 80 on one occasion at least 5 hours apart
B. Systolic BP > 140 or Diastolic BP > 90 on two occasions at least 4 hours apart
C. Systolic BP > 120 or Diastolic BP > 70 on two occasions at least 3 hours apart
D. Systolic BP > 150 or Diastolic BP > 100 on one occasions at least 2 hours apart
B. Systolic BP > 140 or Diastolic BP > 90 on two occasions at least 4 hours apart
Rationale: Preeclampsia is confirmed with a blood pressure measurement of systolic BP > 140 or diastolic BP > 90 on two occasions at least 4 hours apart.
What is the diagnostic criterion for proteinuria in preeclampsia?
A. 24-hour urine specimen of > 100mg/dL or a protein/creatinine ratio of 0.3 mg/dL
B. 24-hour urine specimen of > 200mg/dL or a protein/creatinine ratio of 0.3 mg/dL
C. 24-hour urine specimen of > 300mg/dL or a protein/creatinine ratio of 0.3 mg/dL
D. 24-hour urine specimen of > 400mg/dL or a protein/creatinine ratio of 0.3 mg/dL
C. 24-hour urine specimen of > 300mg/dL or a protein/creatinine ratio of 0.3 mg/dL
Rationale: Proteinuria in preeclampsia is diagnosed with a 24-hour urine specimen of > 300mg/dL or a protein/creatinine ratio of 0.3 mg/dL. A dipstick reading of +1 may also be used in the absence of quantifiable testing.
Which of the following can be used to diagnose preeclampsia in the absence of proteinuria? (Select all that apply)
A. Thrombocytopenia (PLT <100K)
B. Impaired liver function (elevated LFTs (AST/ALT) twice the baseline value)
C. New onset of renal insufficiency (creatinine >1.1 or doubling of serum)
D. Pulmonary edema
E. Headache or Visual Disturbance (cerebral symptoms)
A. Thrombocytopenia (PLT <100K)
B. Impaired liver function (elevated LFTs (AST/ALT) twice the baseline value)
C. New onset of renal insufficiency (creatinine >1.1 or doubling of serum)
D. Pulmonary edema
E. Headache or Visual Disturbance (cerebral symptoms)
Rationale: In the absence of proteinuria, preeclampsia can be diagnosed with thrombocytopenia (PLT <100K), impaired liver function (elevated LFTs (AST/ALT) twice the baseline value), new onset of renal insufficiency (creatinine >1.1 or doubling of serum), pulmonary edema, or headache or visual disturbances (cerebral symptoms).
Which dietary recommendations are given to women with preeclampsia without severe features? (Select all that apply)
A. High-protein diet
B. High-fiber foods
C. High-calorie diet
D. Drink eight to 10 glasses of water daily
A. High-protein diet
B. High-fiber foods
D. Drink eight to 10 glasses of water daily
Rationale: Women are advised to consume a balanced, high-protein diet including high-fiber foods and drink eight to 10 glasses of water daily.
What self-monitoring instructions should be given to women with preeclampsia without severe features? (Select all that apply)
A. Take blood pressure twice daily
B. Record the number of fetal kicks daily
C. Monitor blood sugar levels
D. Track weight daily
A. Take blood pressure twice daily
B. Record the number of fetal kicks daily
Rationale: Women should be instructed to take their own blood pressure twice daily and record the number of fetal kicks daily.
Which symptoms should prompt a woman with preeclampsia without severe features to contact the home health nurse immediately? (Select all that apply)
A. Increase in blood pressure
B. Decrease in fetal activity or movement
C. Stomach pain or excessive heartburn
D. Improved appetite
E. Easy or excessive bruising
A. Increase in blood pressure
B. Decrease in fetal activity or movement
C. Stomach pain or excessive heartburn
E. Easy or excessive bruising
Rationale: Women should contact the home health nurse if they experience an increase in blood pressure, decrease in fetal activity or movement, stomach pain or excessive heartburn, or easy or excessive bruising.
What action should be taken if the condition of a woman with preeclampsia without severe features worsens despite home care?
A. Increase the frequency of home visits
B. Immediately admit her to the hospital
C. Change her dietary plan
D. Increase her physical activity
B. Immediately admit her to the hospital
Rationale: If the condition worsens despite home care, the woman should be immediately admitted to the hospital for further management.
What lifestyle modification is recommended to promote urination and decrease blood pressure in women with preeclampsia without severe features?
A. Increase caloric intake
B. Avoid all forms of exercise
C. Increase salt intake
D. Limit physical activity
D. Limit physical activity
Rationale: Limiting physical activity is recommended to promote urination and subsequently decrease blood pressure.
What position should a woman with severe preeclampsia be kept in while hospitalized?
A. Supine position
B. Left lateral lying position
C. Prone position
D. Sitting position
B. Left lateral lying position
Rationale: The woman with severe preeclampsia should be kept in the left lateral lying position to improve uteroplacental blood flow and reduce blood pressure.
Why should the room be dark and quiet for a woman with severe preeclampsia?
A. To help her sleep
B. To improve her appetite
C. To reduce stimulation
D. To monitor her vital signs
C. To reduce stimulation
Rationale: Keeping the room dark and quiet helps reduce stimulation and prevent seizures in a woman with severe preeclampsia.
What dietary recommendation is given to a woman with severe preeclampsia?
A. High-protein diet with eight to 10 glasses of water daily
B. Low-calorie diet
C. High-carbohydrate diet
D. Low-sodium diet
A. High-protein diet with eight to 10 glasses of water daily
Rationale: A high-protein diet with eight to 10 glasses of water daily is recommended for a woman with severe preeclampsia.
Which signs and symptoms indicate pulmonary edema in a woman with severe preeclampsia? (Select all that apply)
A. Crackles and wheezing on auscultation
B. Dyspnea
C. Decreased oxygen saturation levels
D. Neck vein distention
E. Cough
all of the choices are correct
What testing may be performed to evaluate fetal status in preeclampsia? (Select all that apply)
A. Nonstress test
B. Serial ultrasounds
C. Amniocentesis
D. Doppler velocimetry
E. Biophysical profile
all of the choices are correct
What is the purpose of administering parenteral magnesium sulfate to a woman with severe preeclampsia?
A. To reduce blood pressure
B. To enhance fetal lung maturity
C. To prevent seizures
D. To treat pulmonary edema
C. To prevent seizures
Rationale: Parenteral magnesium sulfate is administered to prevent seizures in a woman with severe preeclampsia.
What indicates magnesium toxicity in a woman receiving magnesium sulfate for severe preeclampsia? (Select all that apply)
A. Respiratory rate less than 12 breaths per minute
B. Absence of deep tendon reflexes (DTRs)
C. Increase in urinary output
D. Decrease in urinary output (less than 30 mL/hr)
A. Respiratory rate less than 12 breaths per minute
B. Absence of deep tendon reflexes (DTRs)
D. Decrease in urinary output (less than 30 mL/hr)
Rationale: Signs of magnesium toxicity include a respiratory rate less than 12 breaths per minute, absence of DTRs, and a decrease in urinary output (less than 30 mL/hr).
What is considered a therapeutic serum magnesium level for a woman receiving magnesium sulfate?
A. 1 to 3 mEq/L
B. 4 to 7 mEq/L
C. 8 to 10 mEq/L
D. 10 to 12 mEq/L
B. 4 to 7 mEq/L
Rationale: Therapeutic serum magnesium levels for a woman receiving magnesium sulfate range from 4 to 7 mEq/L.
What should be done if signs of magnesium toxicity are observed?
A. Administer calcium gluconate as an antidote
B. Continue the current dose of magnesium sulfate
C. Decrease the dose of magnesium sulfate
D. Stop all medications
A. Administer calcium gluconate as an antidote
Rationale: If signs of magnesium toxicity are observed, calcium gluconate should be administered as an antidote.
What is the significance of clonus in a woman with severe preeclampsia?
A. Indicates decreased kidney function
B. Shows decreased neurological status
C. Demonstrates increased risk of seizures
D. Confirms CNS involvement
D. Confirms CNS involvement
Rationale: The presence of clonus confirms CNS involvement in a woman with severe preeclampsia.
How long should the client be monitored for signs and symptoms of preeclampsia/eclampsia after the birth of the newborn?
A. 24 hours
B. 48 hours
C. 72 hours
D. One week
B. 48 hours
Rationale: After the birth of the newborn, the client should be monitored for signs and symptoms of preeclampsia/eclampsia for at least 48 hours.
What is the purpose of continuing magnesium sulfate infusion for 24 hours after delivery?
A. To prevent seizure activity
B. To increase blood pressure
C. To promote diuresis
D. To monitor heart rate
A. To prevent seizure activity
Rationale: Continuing magnesium sulfate infusion for 24 hours after delivery is to prevent seizure activity.
Which routine postpartum assessments should be performed at least every 4 hours? (Select all that apply)
A. Fundus
B. Lochia
C. Breasts
D. Bladder
E. Emotional state
all of the choices are correct
What is a positive sign indicating the resolution of preeclampsia?
A. Increased proteinuria and a decrease in proteinuria
B. Decreased blood pressure and a decrease in proteinuria
C. Decreased urine output and a decrease in proteinuria
D. Diuresis and a decrease in proteinuria
D. Diuresis and a decrease in proteinuria
Rationale: Diuresis, along with a decrease in proteinuria, is a positive sign indicating the resolution of preeclampsia.
Which of the following is a significant risk factor for developing preeclampsia in a subsequent pregnancy?
A. Previous pregnancy without complications
B. Preeclampsia in a prior pregnancy
C. History of anemia
D. Young maternal age
B. Preeclampsia in a prior pregnancy
Rationale: Having preeclampsia in a prior pregnancy is a significant risk factor for developing it again in a subsequent pregnancy.
How does primiparity (first delivery) affect the risk of preeclampsia?
A. It decreases the risk
B. It has no effect on the risk
C. It increases the risk
D. It eliminates the risk
C. It increases the risk
Rationale: Primiparity, or having a first delivery, increases the risk of preeclampsia.
Which chronic condition is associated with an increased risk of preeclampsia? (Select all that apply)
A. Chronic hypertension
B. Chronic bronchitis
C. Chronic renal disease
D. Chronic hyperthyroidism
A. Chronic hypertension
C. Chronic renal disease
Rationale: Chronic hypertension and chronic renal disease are associated with an increased risk of preeclampsia.
Which autoimmune condition is listed as a risk factor for preeclampsia?
A. Rheumatoid arthritis
B. Lupus (SLE)
C. Psoriasi
D. Crohn’s disease
B. Lupus (SLE)
Rationale: Lupus (systemic lupus erythematosus, or SLE) is listed as a risk factor for preeclampsia.
How does maternal age influence the risk of preeclampsia?
A. Age younger than 20 or older than 40 increases the risk
B. Age between 30 and 35 reduces the risk
C. Age younger than 30 has no effect on the risk
D. Age between 35 and 40 with comorbid conditions increases the risk
D. Age between 35 and 40 with comorbid conditions increases the risk
Rationale: Maternal age older than 40, or age 35 with comorbid conditions, increases the risk of developing preeclampsia.
What is the hallmark neurologic complication of preeclampsia?
A. Stroke
B. Hypoglycemia
C. Hypertension
D.Eclampsia
D. Eclampsia
Rationale: Eclampsia is the hallmark neurologic complication of preeclampsia, characterized by the onset of seizure activity.
What is the initial management step during an eclamptic seizure?
A. Administering antihypertensive medication
B. Clearing the airway and administering oxygen
C. Giving IV fluids
D. Monitoring blood pressure
B. Clearing the airway and administering oxygen
Rationale: The initial management step during an eclamptic seizure is to clear the airway and administer adequate oxygen.
What are the complications that can occur during an eclamptic seizure? (Select all that apply)
A. Tongue biting
B. Head trauma
C. Broken bones
D. Aspiration
E. Hyperglycemia
A. Tongue biting
B. Head trauma
C. Broken bones
D. Aspiration
Rationale: Complications during an eclamptic seizure include tongue biting, head trauma, broken bones, and aspiration.
How long should magnesium sulfate be continued after a woman’s last eclamptic seizure?
A. 12 hours
B. 24 hours
C. 36 hours
D. 48 hours
B. 24 hours
Rationale: Magnesium sulfate should be continued for at least 24 hours after the woman’s last eclamptic seizure to prevent further seizures.
What should be closely monitored in women receiving magnesium sulfate? (Select all that apply)
A. Serum magnesium levels
B. Respiratory rate
C. Deep tendon reflexes (DTRs)
D. Urine output
E. Blood glucose levels
A. Serum magnesium levels
B. Respiratory rate
C. Deep tendon reflexes (DTRs)
D. Urine output
Rationale: Serum magnesium levels, respiratory rate, deep tendon reflexes (DTRs), and urine output should be closely monitored to avoid magnesium toxicity.
Which medication is administered IV to prevent further seizures in eclampsia?
A. Calcium gluconate
B. Magnesium sulfate
C. Labetalol
D. Hydralazine
B. Magnesium sulfate
Rationale: Magnesium sulfate is administered IV to prevent further seizures in eclampsia.
What indicates magnesium toxicity in a woman receiving magnesium sulfate? (Select all that apply)
A. Respiratory rate less than 12 breaths per minute
B. Hyperreflexia
C. Absence of deep tendon reflexes (DTRs)
D. Decrease in urinary output (less than 30 mL/hr)
E. Elevated blood pressure
A. Respiratory rate less than 12 breaths per minute
C. Absence of deep tendon reflexes (DTRs)
D. Decrease in urinary output (less than 30 mL/hr)
Rationale: Signs of magnesium toxicity include a respiratory rate less than 12 breaths per minute, absence of deep tendon reflexes (DTRs), and a decrease in urinary output (less than 30 mL/hr).
When should birth via induction or cesarean be performed in a woman with eclampsia?
A. Immediately after the first seizure
B. After the woman’s seizures are controlled
C. Only if the woman remains unstable
D. After 48 hours of observation
B. After the woman’s seizures are controlled
Rationale: Birth via induction or cesarean should be performed after the woman’s seizures are controlled and her stability is assessed.
What is eclampsia characterized by?
A. Onset of coma or seizure in women with preeclampsia
B. Chronic hypertension
C. Severe anemia
D. Hypoglycemia
A. Onset of coma or seizure in women with preeclampsia
Rationale: Eclampsia is characterized by the onset of coma or seizure in women with preeclampsia.
What are the premonitory signs of eclampsia? (Select all that apply)
A. Persistent headache
B. Blurred vision
C. Epigastric or right upper quadrant (RUQ) pain
D. Altered mental status
E. Elevated blood pressure alone
all of the choices are correct
What identifies the onset of eclampsia?
A. High blood pressure
B. Onset of seizure activity
C. Decreased urine output
D. Hyperglycemia
B. Onset of seizure activity
Rationale: The onset of eclampsia is identified by the onset of seizure activity
Which interventions should be performed after seizure activity has ceased? (Select all that apply)
A. Suction the nasopharynx as necessary
B. Administer oxygen
C. Administer antihypertensive medication
D. Continue the magnesium sulfate infusion
E. Encourage the client to walk around
A. Suction the nasopharynx as necessary
B. Administer oxygen
D. Continue the magnesium sulfate infusion
Rationale: After seizure activity has ceased, interventions should include suctioning the nasopharynx as necessary, administering oxygen, and continuing the magnesium sulfate infusion to prevent further seizures. Administering antihypertensive medication may also be necessary, but encouraging the client to walk around is not appropriate immediately after a seizure.
Why should the client be prepared for the birthing process as soon as possible after stabilization?
A. To reduce the risk of preterm birth
B. To minimize the need for pain relief
C. To reduce the risk of perinatal mortality
D. To improve maternal weight gain
C. To reduce the risk of perinatal mortality
Rationale: After the client is stabilized, preparing her for the birthing process as soon as possible helps reduce the risk of perinatal mortality.
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
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.
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.
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.
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.
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
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.
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.
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.
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)
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
Which other medications are often used alongside magnesium sulfate in the management of preeclampsia? SATA
A. Antihypertensives (such as labetalol or hydralazine)
B. Betamethasone or dexamethasone
C. Diuretics (such as furosemide)
D. Antibiotics
A. Antihypertensives (such as labetalol or hydralazine)
B. Betamethasone or dexamethasone
Rationale: Antihypertensives and steroids like betamethasone or dexamethasone are often used alongside magnesium sulfate in managing preeclampsia.
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.
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.
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)
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
Which of the following are risk factors associated with spontaneous abortion? (SATA)
A. Chromosomal abnormalities
B. Maternal age
C. Presence of human chorionic gonadotropin (hCG)
D. Elective termination of pregnancy
A. Chromosomal abnormalities
B. Maternal age
Which condition is most commonly associated with spontaneous abortion in the first trimester?
A. Fetal genetic abnormalities
B. Hypothyroidism
C. Cervical insufficiency
D. Diabetes mellitus
A. Fetal genetic abnormalities
Rationale: The most common cause for first-trimester abortions is fetal genetic abnormalities, usually unrelated to the mother.
Which maternal conditions are commonly related to spontaneous abortion in the second trimester? (SATA)
A. Cervical insufficiency
B. Congenital anomaly of the uterine cavity
C. Use of cocaine
D. Chromosomal abnormalities
A. Cervical insufficiency
B. Congenital anomaly of the uterine cavity
C. Use of cocaine
Rationale: Spontaneous abortions during the second trimester are more likely related to maternal conditions such as cervical insufficiency, congenital anomalies of the uterine cavity, and the use of cocaine. Chromosomal abnormalities are more likely to cause spontaneous abortion in the first trimester.
What is the recommended clinical management for a woman experiencing a first-trimester spontaneous abortion at home without a dilation and curettage (D&C) procedure?
A. Frequent monitoring of hCG levels
B. Hospital admission for labor augmentation
C. Immediate surgical intervention
D. Prescribing antibiotics
A. Frequent monitoring of hCG levels
Rationale: Women experiencing a first-trimester abortion at home without a D&C procedure require frequent monitoring of hCG levels to ensure that all conceptus tissues have been expelled.
What is the primary focus of nursing care for women admitted to the hospital for a second-trimester spontaneous abortion?
A. Administration of medication
B. Frequent monitoring of hCG levels
C. Surgical intervention
D. Providing emotional support
D. Providing emotional support
Rationale: Nursing care for women admitted to the hospital for a second-trimester spontaneous abortion focuses on the care of the laboring woman and providing tremendous emotional support to the woman and her family.
What is the immediate nursing action when a pregnant woman calls and reports vaginal bleeding?
A. Advise her to rest and monitor the situation.
B. Suggest over-the-counter medication.
C. Arrange for her to be seen by a health care professional as soon as possible.
D. Recommend increasing fluid intake.
C. Arrange for her to be seen by a health care professional as soon as possible.
Rationale: When a pregnant woman reports vaginal bleeding, it is crucial for her to be seen by a health care professional as soon as possible to determine the cause.
What assessment information should a nurse obtain from a pregnant woman reporting vaginal bleeding? (SATA)
A. Color of the vaginal bleeding
B. Amount of bleeding
C. Frequency of changing peripads
D. Type of food consumed recently
A. Color of the vaginal bleeding
B. Amount of bleeding
C. Frequency of changing peripad
Rationale: The nurse should ask about the color and amount of vaginal bleeding, and the frequency of changing peripads to determine the severity of the bleeding. The type of food consumed is irrelevant in this situation.
Which nursing intervention is appropriate for a woman presenting with passage of products of conception tissue?
A. Instruct her to save and bring any passed tissue or clots to the health care facility.
B. Advise her to discard the tissue and rest.
C. Recommend taking pain medication.
D. Suggest doing physical exercise.
A. Instruct her to save and bring any passed tissue or clots to the health care facility.
Rationale: The nurse should instruct the woman to save and bring any passed tissue or clots to the health care facility for evaluation.
What is a critical component of psychological support for a woman experiencing a spontaneous abortion?
A. Advising her to avoid future pregnancies.
B. Reassuring her that the abortion usually results from an abnormality and not her actions.
C. Suggesting she move on quickly.
D. Minimizing the significance of the event.
B. Reassuring her that the abortion usually results from an abnormality and not her actions.
Rationale: It is important to reassure the woman that spontaneous abortions usually result from an abnormality and that her actions did not cause the abortion, which helps alleviate guilt and provide psychological support.
Which ongoing assessments are essential for a woman experiencing a spontaneous abortion? (SATA)
A. Monitoring the amount of vaginal bleeding through pad counts
B. Observing for passage of products of conception tissue
C. Assessing the woman’s pain
D. Checking the woman’s body temperature hourly
A. Monitoring the amount of vaginal bleeding through pad counts
B. Observing for passage of products of conception tissue
C. Assessing the woman’s pain
For a woman experiencing a spontaneous abortion, which medication might be administered if she is Rh-negative and not sensitized?
A. Misoprostol
B. Prostaglandin E2 (PGE2)
C. Methotrexate
D. RhoGAM
D. RhoGAM
Rationale: If the woman is Rh-negative and not sensitized, RhoGAM should be administered within 72 hours after the abortion is complete to prevent Rh sensitization.
What diagnostic tool is used to confirm if the sac is empty in a threatened abortion?
A. Ultrasound
B. Blood test
C. Vaginal ultrasound
D. Pelvic exam
C. Vaginal ultrasound
Rationale: A vaginal ultrasound is used to confirm if the gestational sac is empty in cases of threatened abortion.
What is the purpose of vacuum curettage in inevitable abortion?
A. To reduce the risk of excessive bleeding and infection if products of conception are not passed
B. To confirm pregnancy
C. To manage pain
D. To prevent future pregnancies
A. To reduce the risk of excessive bleeding and infection if products of conception are not passed
Rationale: Vacuum curettage is performed to reduce the risk of excessive bleeding and infection if the products of conception are not passed.
What therapeutic management is indicated for incomplete abortion?
A. Bed rest
B. Antibiotic therapy
C. Evacuation of uterus via D&C or prostaglandin analog
D. Dietary changes
C. Evacuation of uterus via D&C or prostaglandin analog
Rationale: Incomplete abortion requires evacuation of the uterus via dilation and curettage (D&C) or administration of prostaglandin analog.
What is the therapeutic management for a missed abortion if inevitable abortion does not occur?
A. Watchful waiting
B. Antibiotic therapy
C. Hormonal therapy
D. Evacuation of uterus
D. Evacuation of uterus
Rationale: Therapeutic management includes evacuation of the uterus or induction of labor to empty the uterus without surgical intervention.
What is a possible therapeutic management for recurrent abortion due to incompetent cervix?
A. Hormonal therapy
B. Bed rest
C. Antibiotic therapy
D. Cervical cerclage
D. Cervical cerclage
Rationale: Cervical cerclage is a procedure performed in the second trimester if the cause of recurrent abortion is an incompetent cervix.
What conservative supportive treatment might be recommended for a woman with threatened abortion?
A. Increased physical activity
B. Antibiotic therapy
C. Conservative Treatment
D. Immediate surgical intervention
C. Conservative Treatment
Rationale: Conservative supportive treatment includes reducing activity, maintaining a nutritious diet, and ensuring adequate hydration
What medications might be used to manage an inevitable abortion if tissue fragments are not completely passed?
A. Prostaglandin analogs
B. Antibiotics
C. Hormonal therapy
D. Pain relievers
A. Prostaglandin analogs
Rationale: Prostaglandin analogs like misoprostol are used to empty the uterus of retained tissue in inevitable abortion.
What is the role of client stabilization in the management of incomplete abortion?
A. Providing dietary advice
B. Encouraging physical exercise
C. Stabilizing the client before proceeding with uterine evacuation
D. Measuring body mass index (BMI)
C. Stabilizing the client before proceeding with uterine evacuation
Rationale: Client stabilization is crucial before performing uterine evacuation in cases of incomplete abortion.
How is a complete abortion confirmed diagnostically?
A. Blood test
B. Pelvic exam
C. Physical symptoms only
D. Ultrasound
D. Ultrasound
Rationale: A complete abortion is confirmed through an ultrasound showing an empty uterus.
What ultrasound finding is indicative of a missed abortion?
A. Absent heart rate
B. Identification of products of conception retained in the uterus
C. Enlarged uterus
D. Increased amniotic fluid
B. Identification of products of conception retained in the uterus
Rationale: Ultrasound can identify the presence of retained products of conception, indicating a missed abortion.
What are potential underlying causes that may be identified and treated in recurrent abortion?
A. High blood pressure
B. Genetic or chromosomal abnormalities, reproductive tract abnormalities, chronic diseases, or immunologic problems
C. Nutritional deficiencies
D. Physical inactivity
B. Genetic or chromosomal abnormalities, reproductive tract abnormalities, chronic diseases, or immunologic problems
What are the signs of a missed abortion?
A. Absent uterine contractions and irregular spotting
B. Increased uterine contractions
C. Severe abdominal pain
D. Profuse bleeding
A. Absent uterine contractions and irregular spotting
Rationale: Missed abortion is characterized by the absence of uterine contractions and irregular spotting.
What diagnostic tools are used to confirm pregnancy loss in inevitable abortion?
A. Ultrasound and hCG levels
B. Physical exam and blood pressure measurement
C. Blood glucose levels
D. Pelvic MRI
A. Ultrasound and hCG levels
Rationale: Ultrasound and hCG levels are used to confirm pregnancy loss in cases of inevitable abortion.
Where can an ectopic pregnancy implant outside the uterine cavity?
A. Fallopian tubes
B. Cervix
C. Ovary
D. All of the above
D. All of the above
Rationale: An ectopic pregnancy can implant in various locations outside the uterine cavity, including the fallopian tubes, cervix, ovary, and the abdominal cavity.
What is the primary cause of maternal mortality in the first trimester of pregnancy in the United States?
A. Gestational diabetes
B. Ectopic pregnancy
C. Pre-eclampsia
D. Placenta previa
B. Ectopic pregnancy
Rationale: Ectopic pregnancy is the primary cause of maternal mortality during the first trimester of pregnancy in the United States.
What are the potential complications of an ectopic pregnancy if left untreated?
A. Massive hemorrhage, infertility, or death
B. Chronic hypertension, infertility, or death
C. Gestational diabetes, infertility, or death
D. Hyperemesis gravidarum, infertility, or death
A. Massive hemorrhage, infertility, or death
Rationale: Untreated ectopic pregnancy can lead to severe complications such as massive hemorrhage, infertility, or death.
Why is prediction of tubal rupture before its occurrence crucial in ectopic pregnancies?
A. To schedule routine ultrasounds
B. To manage gestational diabetes
C. To prevent a potentially life-threatening condition
D. To monitor blood pressure
C. To prevent a potentially life-threatening condition
Rationale: Predicting tubal rupture before it occurs is crucial in ectopic pregnancies to prevent a potentially life-threatening condition and manage the pregnancy loss effectively.
What is the most common site for implantation in an ectopic pregnancy?
A. Cervix
B. Ovary
C. Abdominal cavity
D. Fallopian tubes
D. Fallopian tubes
Rationale: The most common site for implantation in an ectopic pregnancy is the fallopian tubes, accounting for 96% of cases.
What typically causes the fertilized ovum to implant outside the uterus in an ectopic pregnancy?
A. Increased uterine size
B. Arrested or altered journey along the fallopian tube
C. Rapid cell division
D. Genetic mutations
B. Arrested or altered journey along the fallopian tube
Rationale: In an ectopic pregnancy, the fertilized ovum implants outside the uterus due to an arrested or altered journey along the fallopian tube.
What are some associated risk factors for ectopic pregnancy? (SATA)
A. Previous tubal surgery
B. Infertility
C. Use of an intrauterine contraceptive system
D. Increased physical activity
A. Previous tubal surgery
B. Infertility
C. Use of an intrauterine contraceptive system
How does smoking affect the risk of ectopic pregnancy?
A. It has no effect
B. It alters tubal motility
C. It reduces tubal scarring
D. It enhances embryo implantation in the uterus
B. It alters tubal motility, increasing the risk
Rationale: Smoking alters tubal motility, which increases the risk of ectopic pregnancy.
What are safe and effective treatments for clinically stable women diagnosed with nonruptured ectopic pregnancies?
A. Oral antibiotics
B. Laparoscopic surgery or intramuscular (IM) methotrexate administration
C. Bed rest and hydration
D. Hormonal therapy
B. Laparoscopic surgery or intramuscular (IM) methotrexate administration
Rationale: Laparoscopic surgery or intramuscular (IM) methotrexate administration are considered safe and effective treatments for clinically stable women diagnosed with nonruptured ectopic pregnancies.
What classic clinical triad is associated with ectopic pregnancy, although only about half of women present with all three symptoms?
A. Fever, nausea, and vomiting
B. Headache, dizziness, and fatigue
C. Abdominal pain, amenorrhea, and vaginal bleeding
D. Joint pain, rash, and swelling
C. Abdominal pain, amenorrhea, and vaginal bleeding
Rationale: The classic clinical triad of ectopic pregnancy includes abdominal pain, amenorrhea, and vaginal bleeding, although only about half of women present with all three symptoms
What diagnostic procedures are used for a suspected ectopic pregnancy? (SATA)
A. Urine pregnancy test
B. Beta-hCG concentrations
C. Transvaginal ultrasound
D. Complete blood count
A. Urine pregnancy test
B. Beta-hCG concentrations
C. Transvaginal ultrasound
Why is preservation of the affected fallopian tube attempted during surgical intervention for an ectopic pregnancy?
A. To maintain fertility
B. To reduce the risk of infection
C. To improve hormone regulation
D. To enhance blood circulation
A. To maintain fertility
Rationale: During surgical intervention for an ectopic pregnancy, preservation of the affected fallopian tube is attempted to maintain fertility.
What criteria must a client meet to be eligible for medical therapy with methotrexate for an ectopic pregnancy?
A. Hemodynamically unstable and high beta-hCG levels
B. Active bleeding in the peritoneal cavity and a ruptured mass
C. Hemodynamically stable
D. Severe persistent abdominal pain and liver disease
C. Hemodynamically stable
Rationale: To be eligible for medical therapy with methotrexate, the client must be hemodynamically stable, with no signs of active bleeding in the peritoneal cavity, low beta-hCG levels (lower than 5,000 mIU/mL), and the mass must be unruptured and measure less than 4 cm as determined by ultrasound.
What is a contraindication to medical treatment with methotrexate for ectopic pregnancy?
A. Low beta-hCG levels
B. Renal or liver disease
C. Small unruptured mass
D. No signs of active bleeding
B. Renal or liver disease
Rationale: Renal or liver disease is a contraindication to medical treatment with methotrexate for ectopic pregnancy.
What are the advantages of using methotrexate for the medical management of ectopic pregnancy? (SATA)
A. Avoidance of surgery
B. Preservation of tubal patency and function
C. Lower cost
D. Immediate pain relief
A. Avoidance of surgery
B. Preservation of tubal patency and function
C. Lower cost
What is the main mechanism of action of methotrexate in treating ectopic pregnancy?
A. Promoting embryo growth
B. Increasing blood supply
C. Enhancing tubal motility
D. Inhibiting cell division in the developing embryo
D. Inhibiting cell division in the developing embryo
Rationale: Methotrexate is a folic acid antagonist that inhibits cell division in the developing embryo, which is its main mechanism of action in treating ectopic pregnancy.
What adverse effects are associated with methotrexate treatment for ectopic pregnancy?
A. Nausea, vomiting, stomatitis, diarrhea, gastric upset, increased abdominal pain, and dizziness
B. Hair loss and weight gain
C. Hypertension and hyperglycemia
D. Skin rash and joint pain
A. Nausea, vomiting, stomatitis, diarrhea, gastric upset, increased abdominal pain, and dizziness
Rationale: Adverse effects associated with methotrexate treatment for ectopic pregnancy include nausea, vomiting, stomatitis, diarrhea, gastric upset, increased abdominal pain, and dizziness.
What follow-up care is necessary after methotrexate administration for ectopic pregnancy?
A. Monthly check-ups
B. Immediate surgical intervention
C. Weekly laboratory studies until beta-hCG titers decrease
D. Daily physical therapy sessions
C. Weekly laboratory studies until beta-hCG titers decrease
Rationale: After methotrexate administration for ectopic pregnancy, the woman is instructed to return weekly for follow-up laboratory studies until beta-hCG titers decrease.
What surgical procedure might be performed to preserve the fallopian tube in an unruptured ectopic pregnancy?
A. Laparotomy
B. Linear salpingostomy
C. Salpingectomy
D. Hysterectomy
B. Linear salpingostomy
Rationale: In an unruptured ectopic pregnancy, a linear salpingostomy may be performed to preserve the fallopian tube and maintain future fertility.
What is the primary reason for surgery in cases of ruptured ectopic pregnancy?
A. To enhance fertility
B. To control possible uncontrolled hemorrhage
C. To diagnose ectopic pregnancy
D. To prevent future pregnancies
B. To control possible uncontrolled hemorrhage
Rationale: Surgery is necessary in cases of ruptured ectopic pregnancy to control possible uncontrolled hemorrhage, which is a medical emergency.
What is the significance of monitoring beta-hCG levels until they are undetectable following treatment for ectopic pregnancy?
A. To confirm pregnancy
B. To ensure that any residual trophoblastic tissue that forms the placenta is gone
C. To assess liver function
D. To measure kidney function
B. To ensure that any residual trophoblastic tissue that forms the placenta is gone
Rationale: Monitoring beta-hCG levels until they are undetectable ensures that any residual trophoblastic tissue that forms the placenta is completely removed.
What is the primary focus of nursing assessment in a woman with a suspected ectopic pregnancy?
A. Determining the presence of urinary tract infection
B. Assessing nutritional status
C. Determining the existence of an ectopic pregnancy and whether or not it has ruptured
D. Evaluating blood glucose levels
C. Determining the existence of an ectopic pregnancy and whether or not it has ruptured
Rationale: The primary focus of nursing assessment is determining the existence of an ectopic pregnancy and whether or not it has ruptured.
When do signs and symptoms of ectopic pregnancy typically begin?
A. Immediately after conception
B. At about the 4th or 5th week of gestation
C. At about the 7th or 8th week of gestation
D. At about the 10th or 11th week of gestation
C. At about the 7th or 8th week of gestation
Rationale: The signs and symptoms of ectopic pregnancy usually begin at about the 7th or 8th week of gestation.
What is the hallmark sign of ectopic pregnancy?
A. Severe headache with spotting within 6 to 8 weeks after a missed menstrual period
B. Abdominal pain with spotting within 6 to 8 weeks after a missed menstrual period
C. High fever with spotting within 6 to 8 weeks after a missed menstrual period
D. Leg cramps with spotting within 6 to 8 weeks after a missed menstrual period
B. Abdominal pain with spotting within 6 to 8 weeks after a missed menstrual period
What are some possible contributing factors to ectopic pregnancy? (SATA)
A. Previous ectopic pregnancy
B. History of sexually transmitted infections (STIs)
C. Fallopian tube scarring from PID
D. Recent physical trauma
A. Previous ectopic pregnancy
B. History of sexually transmitted infections (STIs)
C. Fallopian tube scarring from PID
What symptoms might indicate an unruptured tubal pregnancy?
A. Severe lower back pain and high fever
B. Missed menstrual period, adnexal fullness, and tenderness
C. Chronic cough and difficulty breathing
D. Swelling in the legs
B. Missed menstrual period, adnexal fullness, and tenderness
What are common symptoms typical of early pregnancy that can also be present in ectopic pregnancy?
A. High blood pressure and increased urination
B. Breast tenderness, nausea, fatigue, shoulder pain, and low back pain
C. Increased appetite and weight gain
D. Headache and dizziness
B. Breast tenderness, nausea, fatigue, shoulder pain, and low back pain
