hypertension RELIAS
Which of the following are considered major risk factors for the development of preeclampsia? Select all that apply. Chronic hypertension Family history of preeclampsia Smoking Multiparity
Chronic hypertension Family history of preeclampsia Smoking
A 38-year-old G2P1 at 24 weeks' gestation presents for an initial prenatal visit and is found to have a blood pressure of 135/85 mm Hg. She has no other signs or symptoms of preeclampsia, and urine dipstick is negative for protein. Her medical records arrive and indicate a pre-existing diagnosis of chronic hypertension. Which of the following statements is accurate? Select all that apply. Current blood pressure is below the 140/90 mm Hg threshold, so the previous diagnosis is incorrect. The absence of proteinuria rules out superimposed preeclampsia. The diagnostic threshold of 140/90 mm Hg does not apply to patients with pre-existing chronic hypertension. Patient should just be scheduled for a routine prenatal visit in 4 weeks. Pre-pregnancy and early pregnancy baseline blood pressure values would be useful in determining the correct diagnosis.
$ The diagnostic threshold of 140/90 mm Hg does not apply to patients with pre-existing chronic hypertension. $ Pre-pregnancy and early pregnancy baseline blood pressure values would be useful in determining the correct diagnosis.
Hematologic abnormalities are common clinical manifestations of preeclampsia and other hypertensive disorders of pregnancy. Which of the following statements are accurate?
$. *Hemolysis can result when red blood cells pass through vasoconstricted microvasculature and become fragmented. *Thrombocytopenia can occur from the accelerated use of platelets to form clots in damaged microvasculature.
A 34-year-old G1 at 33 weeks with chronic hypertension is admitted for further evaluation after a BP of 164/98 mm Hg was found in the clinic. Her repeat BPs are in the 160s-110s mm Hg and do not decrease with IV antihypertensives. What are the next steps in her care?
*Administer beta steroids and begin labor induction. *Start magnesium sulfate for seizure prophylaxis. Cesarean delivery. Stop IV antihypertensives, and convert to long-acting oral antihypertensives.
A 30-year-old G2P1 at 36 weeks is diagnosed with mild gestational hypertension (blood pressure range 140-150/90-95 mm Hg), and close maternal and fetal outpatient monitoring is initiated. If the patient presents 1 week later with a persistent headache but no proteinuria, how would your diagnosis change?
*Change the diagnosis to severe gestational hypertension. Change the diagnosis to preeclampsia with severe features. Change the diagnosis to preeclampsia without severe features. No change in diagnosis
Ms. Sandoval is a 28-year-old G1P0 at 33 4/7 weeks' gestation on your antepartum unit to rule out superimposed preeclampsia. Ms. Sandoval suffers from chronic hypertension that has been previously controlled with oral antihypertensive medication. At her last prenatal visit, her hypertension had worsened, so she was sent to your unit for evaluation. She declines symptoms of severe features. Her obstetrician has ordered serial blood pressures, a 24-hour urine collection, preeclampsia labs, and an ultrasound for fetal growth. What other interventions or orders can you anticipate from the obstetrician?
*Corticosteroid administration, if not already administered during this pregnancy Immediate cesarean delivery Induction of labor Discharge to follow up in the office
Magnesium sulfate is the medication of choice to prevent and treat eclamptic seizures. Which of the following statements about magnesium sulfate is accurate?Can only be administered intravenously even if an intravenous line is not in place.In a patient with recurrent seizures who is currently on magnesium sulfate, this medication should be immediately abandoned.The typical maintenance dose for magnesium sulfate is between 4-6 grams/hour.*Magnesium levels may need to be monitored in patients with renal insufficiency.
*Magnesium levels may need to be monitored in patients with renal insufficiency.$$$$
In The American College of Obstetricians and Gynecologists' 2013 Task Force publication on Hypertension in Pregnancy, important classification and nomenclature updates were released. Which of the following terms is consistent with the new guidelines?
*Preeclampsia without severe features *Preeclampsia with mild features Pregnancy-induced hypertension Mild preeclampsia *Gestational hypertension
What percentage of maternal deaths from preeclampsia-associated complications are thought to be preventable? Select an answer. 20% 40% 60% 80%
20
Hypertensive disorders of pregnancy can affect up to what percentage of pregnancies? Select an answer. 10% 22% 25% 40%
22
The timing of the onset of preeclampsia has been the subject of much research. The disease can be thought of as 2 subclasses (early-onset and late-onset), which have some important distinctions. Which of the following statements is accurate with regard to early-onset disease compared to late-onset disease? Select an answer. Defined as disease onset prior to 37 weeks' gestation. Occurs more frequently than late-onset disease. Associated with greater fetal and maternal morbidity and mortality. Progresses more slowly than late-onset disease.
??Associated with greater fetal and maternal morbidity and mortality
All of the patients described below have potential risk for developing preeclampsia. However, which of the following profiles confers the highest magnitude of risk? Select an answer. A 30-year-old G1P0 smoker with a family history of preeclampsia. A 30-year-old G1P0 smoker with a family history of preeclampsia. A 28-year-old G2P0 African American woman with a history of 10-week spontaneous abortion. A 30-year-old G2P1 with a history of preeclampsia at 30 weeks' gestation.
A 30-year-old G1P0 smoker with a family history of preeclampsia.
Ms. Williams is a 32-year-old African American, nulliparous woman who presents to labor and delivery triage for evaluation of headache. You find that she is obese, with a BMI of 43, and suffers from type II diabetes and chronic hypertension. Which risk factors increase her risk of developing preeclampsia? Select all that apply. Age Chronic hypertension Race Type II diabetes BMI
ALL
While a team is doing a simulation, a provider has a question about what medication would be best in this situation. What should the sim leader do?
Answer the provider's question and then continue with the simulation. Point to the book that has the answer so that the provider can look up the answer. *Join the simulation for a few minutes, and provide the answer. Continue the simulation, and let the team work through the clinical situation.
If a nulligravid patient would like to know her risk of preeclampsia with pregnancy, which lab tests are most useful in predicting the risk of developing preeclampsia?
Anticardiolipin antibody Calcium Magnesium Creatinine *None of the choices
A 28-year-old G2P0 with a history of well-controlled chronic hypertension on labetalol 200 mg BID has an elevated BP of 155/95 mm Hg noted at the time of her 34-week scheduled prenatal visit. A urine dipstick performed is negative for protein. Appropriate management at this time would include which of the following? Select 3 answers. Assess for signs/symptoms of preeclampsia Increase her dose of labetalol Check preeclamptic labs (CBC, liver enzymes, creatinine) Discharge with 1-week follow-up plan for blood pressure check Perform fetal nonstress testing
Assess for signs/symptoms of preeclampsia Check preeclamptic labs (CBC, liver enzymes, creatinine) Perform fetal nonstress testing
What are the diagnostic criteria for gestational hypertension? Select 2 answers. 1+ proteinuria Blood pressure >140/90 mm Hg on 2 occasions, 4 hours apart Normalization of blood pressure by 6 weeks postpartum No history of hypertensive disorders in prior pregnancies Gestational age >20 weeks
Blood pressure >140/90 mm Hg on 2 occasions, 4 hours apart Gestational age >20 weeks
Ms. Romano is a 21-year-old G1P0 at 32 weeks' gestation who was admitted to your unit for elevated blood pressures. Her initial blood pressure was 168/100 mm Hg, and a repeat value 15 minutes later was 164/96 mm Hg. Ms. Romano suffers from chronic hypertension, but her blood pressures have been <140/90 mm Hg during this pregnancy. She is also complaining of a moderate headache that was unresponsive to medication she took prior to arriving to the hospital. When calling Ms. Romano's physician, the nurse provides report in an SBAR format and recommends IV antihypertensive medication. The physician states she would like to perform serial blood pressures over the next hour before treating the blood pressure. Which communication tool should the nurse use in response? Select an answer. Validate and Verify Shout out/Call back CUSS SBAR+R
CUSS?
The obstetric team is called to a room to see a 23-year-old G1 who arrived at the unit 5 minutes ago. She has a history of chronic hypertension and now has a severe headache and visual changes. The nurse presents an SBAR about this event, asks for orders, and is asked to obtain preeclamptic labs. She asks if the provider would like to treat the BP, which has now been over 170/110 mm Hg twice in 15 minutes. The provider asks that they be called when the labs are back to make another decision. What is the appropriate tool for the nurse to use?
Call out Validate and verify IPASS ***"Stop the Line"
Which of the following statements about placental hypoperfusion/ischemia is correct? Select all that apply. Can be the result of chronic vascular insufficiencies such as diabetes and lupus. Not thought to be a central pathogenic event in early-onset preeclampsia/HIP. Can lead to impaired fetal growth and oligohydramnios. Results from maternal spiral artery remodeling to high capacity, low resistance blood vessels.
Can be the result of chronic vascular insufficiencies such as diabetes and lupus. Can lead to impaired fetal growth and oligohydramnios. $
What is the best strategy to improve the care of patients with hypertensive disease in pregnancy? Select an answer. Admit all patients to the hospital when their BP is found to be over 140 mm Hg systolic or 90 mm Hg diastolic. Send preeclampsia labs for patients at 28 and 35 weeks. Implement a series of interventions to improve the identification and treatment of hypertensive disease. Check baseline preeclampsia labs for all patients at their initial prenatal visit in case there is a need for comparison later in pregnancy.
Check baseline preeclampsia labs for all patients at their initial prenatal visit in case there is a need for comparison later in pregnancy.
Ms. Lee is a 33-year-old G1P1 who had labor induction for preeclampsia with severe features, resulting in a vaginal delivery 3 hours ago. She remains on magnesium sulfate IV. Her BPs have remained in the 150s/90s mm Hg on oral labetalol, and her lab exams were all within normal limits except creatinine, which is 1.5mg/dL. She reports that she is short of breath and feels chest heaviness. She then becomes unresponsive. What are the correct actions at this time?
Check creatinine immediately IV labetalol immediately *Calcium gluconate immediately *Stop magnesium sulfate
Which of the following are considered major risk factors for the development of preeclampsia? Select 3 answers. Chronic hypertension Caucasian race Cigarette smoking Multiple gestation Antiphospholipid syndrome
Chronic htx, smoking, anti phospholipid
Which maternal condition(s) increase the risk of abnormal placentation or preeclampsia development? Select all that apply. Chronic hypertension Diabetes SLE Chronic asthma Chronic kidney disease
Chronic hypertension Diabetes
A 34-year-old G2P1 at 28 weeks' gestation has a history of chronic essential hypertension managed with oral nifedipine 30 mg per day. Her blood pressures prior to and during the pregnancy were in the range of 130-140/80-90 mm Hg. She has recently been admitted to the hospital because of increasing blood pressure and is now on oral labetalol 600 mg BID and nifedipine 90 mg daily. Her blood pressures on this new regimen of medications have been 150-170/90-110 mm Hg for the past day. Preeclampsia labs are within normal limits, except her serum creatinine is now 1.3 (baseline 0.8). Urine protein has remained 1+ on urine dipstick since the beginning of her pregnancy. What is the likely diagnosis? Select an answer. HELLP syndrome Worsening severe chronic hypertension Chronic hypertension with superimposed preeclampsia Severe gestational hypertension
Chronic hypertension with superimposed preeclampsia
Which of the following is the most important element of an effective simulation drill? Select an answer. Includes use of a realistic manikin Timing of the drill unknown to participants Clinically realistic, relevant scenario Performed in a simulation lab
Clinically realistic, relevant scenario
A 30-year-old G1P0 at 32 weeks' gestation presents for a routine prenatal visit. She has no prior risk factors for hypertensive disease in pregnancy. Her blood pressure is 136/84 mm Hg. She has no neurologic symptoms or other complaints. Which of the following are accepted diagnostic tests for preeclampsia? Select all that apply. Magnesium Creatinine Uric acid Platelet count AST, ALT
Creatinine Platelet count AST, ALT
For a patient diagnosed with preeclampsia with severe features at 32 weeks' gestation, which of the following findings would be a contraindication to limited expectant management for steroid benefit? Select all that apply. Eclampsia Fetal growth restriction Oligohydramnios (AFI <5cm) Pulmonary edema
Eclampsia Pulmonary edema Uncontrollable severe hypertension
The key to patient safety when treating a hypertensive disease of pregnancy, or any obstetric emergency, is: Select all that apply. Effective communication, especially during emergency situations, and change in shift/provider care. Always following the physician's plan of care as he or she is the clinician with the most knowledge. Utilizing a shared mental model where all team members have a common understanding of each other's roles. The physician or other clinical provider should only concentrate on their knowledge and clinical role and should not worry about understanding the nurses' role and knowledge.
Effective communication, especially during emergency situations, and change in shift/provider care. Utilizing a shared mental model where all team members have a common understanding of each other's roles.
Ms. Sato is a 19-year-old G1P0 who presents for prenatal care at 14 weeks' gestation. Her initial blood pressure is 142/90 mm Hg. She denies any medical or surgical history, stating that she does not see a doctor regularly because she "is healthy." Her BMI is 35. Her second prenatal visit occurs at 16 weeks' gestation, and her blood pressure is 144/90 mm Hg. What hypertensive disorder of pregnancy do you suspect that Ms. Sato is suffering from?
Gestational hypertension Preeclampsia *Chronic hypertension Superimposed preeclampsia
Which of the following statements are true about mode of delivery in patients with preeclampsia/HIP? Select all that apply. Induction of labor is not recommended in patients with HELLP syndrome. Induction of labor should not be attempted in patients who are on magnesium sulfate. For women undergoing labor induction, the likelihood of cesarean delivery increases with decreasing gestational age. Cesarean delivery rates are >90% when labor induction is attempted at a gestational age <28 weeks. If cesarean delivery is indicated, magnesium sulfate should be discontinued during the procedure.
Induction of labor is not recommended in patients with HELLP syndrome.??? For women undergoing labor induction, the likelihood of cesarean delivery increases with decreasing gestational age.??? Cesarean delivery rates are >90% when labor induction is attempted at a gestational age <28 weeks.???
Ms. Sato is a 21-year-old G1P0 who begins prenatal care at 12 weeks' gestation. She is obese, with a BMI of 41, and suffers from chronic hypertension. Which of the following proven strategies will be recommended to Ms. Sato to lower her risk of developing preeclampsia? Select all that apply. Low-dose aspirin daily Dietary salt restriction Restriction of physical activity Additional antioxidant medications such as vitamins C and E
Low-dose aspirin daily Dietary salt restriction
Unit-based hypertension simulation drills are useful for the team in what ways? Select all that apply. They help people learn each other's names. Medication location and availability is checked. Communication tools can be practiced. Good practice is reinforced.
Medication location and availability is checked. Communication tools can be practiced. Good practice is reinforced.
Patients who have a high risk of preeclampsia should have which of the following done in the first trimester? Select all that apply. Nutrition consult regarding salt intake Daily aspirin initiation Baseline preeclamptic labs Ultrasound for dating
Nutrition consult regarding salt intake Baseline preeclamptic labs Ultrasound for dating?
A 35-year-old G1P0 at 32 weeks presents to labor and delivery triage with vague symptoms of malaise and decreased fetal movement over the past 12 hours. She vomited shortly before coming in today but, otherwise, denies abnormal symptoms. The fetal heart rate tracing shows a baseline rate of 130 BPM with moderate variability, and there are no decelerations or accelerations. Maternal blood pressure is 130/75 mm Hg, and urine dip is negative for protein. After calling report to the provider, labs are sent for further information. If the assessment is... The patient may have HELLP syndrome. And then you find... Serum LDH is elevated at 650 IU/L. Then the initial assessment becomes...
POSS SUPPORTED
Why is it important to know the renal function of a patient with preeclampsia with severe features? Select an answer. It affects magnesium sulfate dosing. It will influence which antihypertensives are given. It is used to determine the severity of preeclampsia. Patients with increased creatinine will also have increased proteinuria.
Patients with increased creatinine will also have increased proteinuria.??
Which of the following statements is false concerning preeclampsia with severe features? Select an answer. Patients with preeclampsia with severe features should be delivered by cesarean section. If ≥34 weeks' gestation, a woman with preeclampsia with severe features should be stabilized, have magnesium sulfate initiated, and immediate delivery should occur. If delivery is delayed for patients <34 weeks' gestation to promote fetal lung maturity with corticosteroids, this should be undertaken at level III or IV maternal/neonatal facilities. Antihypertensive therapy should be administered in patients whose systolic BP is ≥160 mm Hg or diastolic BP is ≥110 mm Hg.
Patients with preeclampsia with severe features should be delivered by cesarean section.$
A 40-year-old G1P0 is admitted at 34 weeks' gestation with a diagnosis of preeclampsia with severe features. The patient's blood pressure is 170/110 mm Hg. Her nurse is starting magnesium sulfate when the provider walks into the room. The provider requests that the nurse give labetalol 10 mg IV push. Which communication tool will the nurse use in this situation?SBAR"Stop the Line" phrase*CUSSValidate and VerifyShout out/call back
SBAR "Stop the Line" phrase *CUSS Validate and Verify
A 19-year-old woman, who delivered 1 week ago by normal vaginal delivery, returns to the hospital today with a severe headache. Her blood pressure is 130/84 mm Hg in the Semi-Fowler's position. Her husband reports that she has been sleeping poorly-caring for the baby. Her serum creatinine is 1.2 mg/dL. A diagnosis of preeclampsia with severe features would be supported by which of the following?
Select 2 answers. The patient has a history of seizures. *Her liver enzymes are more than twice normal. *She has a grand mal seizure at this time.?? She experienced a preterm birth with this delivery.
Which of the following statements regarding the use of low-dose aspirin for preeclampsia prevention is correct? Select an answer. Use of low-dose aspirin is associated with an increased risk for placental abruption. The minimal effective dose of baby aspirin is 81mg/D. Is advised for low-risk patients. Should be initiated before 12-16 weeks' gestation.
Should be initiated before 12-16 weeks' gestation.$
Contraindications to expectant management of gestational hypertension at 35 weeks' gestation include which of the following? Select all that apply. Ultrasound estimated fetal weight <5th percentile Suspected placental abruption Premature rupture of membranes Amniotic fluid volume <8 cm Elevated umbilical artery S/D ratio
Ultrasound estimated fetal weight <5th percentileSuspected placental abruptionPremature rupture of membranes$
Which of the following is the best explanation for why proteinuria is not a requisite for the diagnosis of preeclampsia? Select an answer. Variability in proteinuria assessment Variability in proteinuria over time Variability in degree of renal involvement amongst preeclamptic patients Variability in assessment of proteinuria in hypertensive pregnant patient
Variability in degree of renal involvement amongst preeclamptic patients$
A 39-year-old G1P0 at 35 weeks' gestation has had systolic blood pressures in the 130s mm Hg and diastolic blood pressures in the 80s mm Hg. She has occasional headaches, which resolve with over-the-counter analgesics. What is the best course of action? Select 2 answers. Bed rest Weekly blood pressure monitoring Dietary salt restriction Initiate low-dose aspirin Discuss symptoms of preeclampsia
Weekly blood pressure monitoring Discuss symptoms of preeclampsia
A 39-year-old G1P0 at 35 weeks' gestation has had systolic blood pressures in the 130s and diastolic blood pressures in the 80s, and she has occasional headaches which resolve with over-the-counter analgesics. What is the best course of action? Select all that apply. Bed rest Weekly blood pressure monitoring Dietary salt restriction Initiate low-dose aspirin Discuss symptoms of preeclampsia
Weekly blood pressure monitoring Initiate low-dose aspirin Discuss symptoms of preeclampsia
A 29-year-old G2P1 with a history of chronic hypertension is being seen for her first prenatal visit at 20 weeks' gestation. Her BP is 128/78 mm Hg without medications. She is very happy to have such a low BP. Why is it so low? Select all that apply. It is normal for the BP to decrease in the second trimester, regardless of hypertensive status. You may have used a cuff that was too large. She had previously started aspirin, and it is keeping her BP decreased. Your office environment has a very relaxing effect on patients.
You may have used a cuff that was too large. She had previously started aspirin, and it is keeping her BP decreased.
Daily baby aspirin started in the late first trimester may help to reduce the risks from preeclampsia in patients at risk based upon which of the following? Select all that apply. Nulliparity Prior history of preeclampsia Maternal systemic lupus erythematosus Chronic hypertension Twin gestation
all?
Which of the following is NOT a standard definition of hypertensive disease during pregnancy? Select an answer. Preeclampsia with severe features Atypical preeclampsia Chronic hypertension Gestational hypertension
atypical
A hypertensive simulation is scheduled for this morning. Only 5 of the 6 people scheduled for the simulation have shown up. What should the nurses and providers do? Select an answer. Cancel the simulation. Proceed with the simulation, but leave out the tasks/work of the 6th person in the sim. Do the simulation, and adjust roles so that all the tasks are done. Change the simulation to make it appropriate for 4-5 people.
adjust roles
A 30-year-old G3P2 with a negative history of hypertensive disorders of pregnancy in prior pregnancies presents at 32 weeks' gestation with a headache, nausea, and mild cramping. Her blood pressure is 142/80 mm Hg. She has a cough, and her temperature is 38.1℃ (100.7℉). Which of the following conditions is included in the differential? Select an answer. Influenza Pneumonia Preeclampsia Urinary tract infection Any of these conditions
all
Which of the following findings are currently accepted as severe features of preeclampsia according to the recent American College of Obstetricians and Gynecologists Task Force diagnostic guidelines? Select all that apply. Severe persistent RUQ pain not accounted for by alternate diagnosis Pulmonary edema Fetal growth restriction Proteinuria >5g/24 hours Doubling of serum creatinine without pre-existing renal disease
idk Pulmonary edema Fetal growth restriction Proteinuria >5g/24 hours Doubling of serum creatinine without pre-existing renal disease
A 28-year-old G2P1 is considering becoming pregnant. She tells you that her prior pregnancy was complicated by preeclampsia diagnosed at 17 weeks. Her blood pressure today is 146/92 mm Hg. What is the likely diagnosis for her last pregnancy? Select an answer. Systemic lupus erythematosus Chronic hypertension Gestational hypertension Preeclampsia
chronic
Ms. Gupta is a 29-year-old G1P0 who came in for prenatal care at 8 weeks' gestation. She denies any medical history and claims to be "healthy with no problems." Her initial blood pressure at intake was 142/90 mm Hg. Subsequent readings at 12 and 16 weeks' gestation were 144/92 mm Hg and 141/94 mm Hg, respectively. What do you suspect? Select an answer. Preeclampsia Superimposed preeclampsia Chronic hypertension Gestational hypertension
chronic htx
ms adams 29 G1P0 prenatal visit at 8wk, denies medical hx and claims healthy no problems. initial bp 142/90, at 12wk were 144/92 and 141/94. what do you suspect?
chronic htx
Which of the following preeclampsia methodologies is superior? Select an answer. Risk-based screening Biochemical-based screening Biophysical-based screening Combined screening
combo$
With respect to management of gestational hypertension and preeclampsia without severe features, which of the following statements is accurate? Select an answer. Expectant management is recommended until 39 weeks' gestation with stable maternal and fetal conditions. Magnesium sulfate is universally recommended for the prevention of eclampsia. Delivery, rather than expectant management, is recommended at or beyond 37 weeks' gestation. Antihypertensive medication is recommended foIn the pathogenic model for preeclampsia, a key early mechanism of disease is placental hypoperfusion and ischemia. Severity of this event varies and correlates with the timing and presence of clinical sequelae. In the described cascade of events, which of the following represents a potential early and direct clinical consequence of severe placental hypoperfusion? Select an answer. Peripheral edema Hypertension Hepatic necrosis Oligohydramniosr SBPs that exceed 140 mm Hg or DBPs that exceed 90 mm Hg.
deliver 37?
A 35-year-old G2P1 with a known history of well-controlled chronic hypertension (BP: 130/90 mm Hg on average) has been managed on labetalol 200 mg PO BID. She is found to have elevated blood pressures (150/100 mm Hg) at her 30-week scheduled prenatal visit. She is, otherwise, without complaints, and a urine dipstick is negative for protein.Which of the following actions is most appropriate at this time? Select an answer. Recheck maternal BP after a period of rest on her left side. Send home and schedule outpatient BP check in 1 week. Increase labetalol to 300 mg PO BID. Referral to labor and delivery for further evaluation. Send home to collect a 24-hour urine protein.
further evaluation
A 38-year-old G1P1 delivered her first child 4 months ago. During that pregnancy, she had elevated blood pressures (135-145/85-90 mm Hg) noted after 22 weeks' gestation with no other abnormal findings and had a term vaginal delivery. She presents to her PCP's office today for a possible urinary tract infection. The nurse reports her vital signs as follows: T 37.2℃ (99.0℉), HR 80 BPM, BP 145/90 mm Hg. Which American College of Obstetricians and Gynecologists category of hypertensive disorders of pregnancy most likely reflects this patient's recent pregnancy diagnosis? Select an answer. Gestational hypertension Chronic hypertension Chronic hypertension with superimposed preeclampsia Preeclampsia
gest htx $
A 40-year-old G2P1 presents for a routine prenatal visit at 34 weeks. She has known chronic hypertension with baseline mild proteinuria (trace to +1 consistently at all of her visits since 10 weeks). Her blood pressures have consistently ranged between 130-150/90-100 mm Hg without medications, and she has displayed no other signs or symptoms of superimposed preeclampsia. Serial growth ultrasounds and antenatal testing have all been normal. If the assessment is... The patient has chronic hypertension with baseline mild chronic kidney disease. And then you find... The urine dip at this visit is +2.
invalidated?
A 29-year-old G2P1 presents for her first prenatal visit at 22 weeks' gestation. Her blood pressure is 144/90 mm Hg, and her urine dipstick is negative for protein. She denies any signs or symptoms of preeclampsia, and lab work is pending. Fetal ultrasound shows the fetal heart rate is in the 150s with the estimated fetal weight in the 40th percentile. Which of the following categories of hypertensive disorders of pregnancy can be excluded? Select an answer. Preeclampsia Chronic (preexisting) hypertension Gestational hypertension Chronic hypertension with superimposed preeclampsia None of the diagnoses can be excluded
none?
In the pathogenic model for preeclampsia, a key early mechanism of disease is placental hypoperfusion and ischemia. Severity of this event varies and correlates with the timing and presence of clinical sequelae. In the described cascade of events, which of the following represents a potential early and direct clinical consequence of severe placental hypoperfusion? Select an answer. Peripheral edema Hypertension Hepatic necrosis Oligohydramnios
oligo
A 36-year-old G2P1001 at 31 weeks' gestation presents to her PCP's office with complaints of nausea and epigastric discomfort since she awoke this morning. She states that her husband has been sick with a stomach virus, and he has had similar symptoms. The NST is reactive, and her blood pressure is 140/90 mm Hg in the office today (previous prenatal visit BP was 110/70 mm Hg). If the assessment is... Preeclampsia is the likely diagnosis. And then you find... The mother's urine dip is negative for protein.
poss invalid
A 25-year-old nulliparous patient at 30 weeks' gestation arrives to the emergency room with a sore throat. She is found to have a blood pressure of 150/90 mm Hg. She is sent to labor and delivery for further evaluation of the hypertension. The blood pressure is repeated while she is in the Semi-Fowler's position and noted to be 128/70 mm Hg. If the assessment is... The patient may have preeclampsia. And then you find... She has been taking over-the-counter medications for nasal congestion.
poss invalidated
A 33-year-old G1P0 at 30 weeks is admitted following a 2-week history of progressive foot and hand edema, and a 2-3-day history of headaches unrelieved with acetaminophen. Her blood pressure was 150/100 mm Hg, and a urine dipstick revealed 2+ protein. Preeclamptic labs were notable for minimally elevated liver function tests. Fetal testing was reassuring. Magnesium sulfate was started, and the first dose of corticosteroids was administered. If the plan is to... Attempt expectant management for full corticosteroid benefit. And then you find... Severe hypertension develops and is poorly controlled with intravenous labetalol.
poss invalidated
A 31-year-old G1P1 presents to the office 2 weeks postpartum for an incision check after an uncomplicated cesarean delivery for failure to progress. She has no history of hypertension. Her blood pressure at this visit is 150/90 mm Hg. She notes moderate incisional pain for which she is taking acetaminophen. Liver function testing, CBC with platelets, renal testing, and urine dip for protein are all normal. If the assessment is... You are suspicious for preeclampsia. And then you find... The patient calls later that night complaining of a headache.
poss suportive
A 27-year-old G1P0 with a twin gestation at 32 weeks presents to labor and delivery for a preeclampsia evaluation after elevated blood pressures were noted at her scheduled prenatal visit. The patient's blood pressures on labor and delivery range from 130-142/90-94 mm Hg. Urine protein/creatinine ratio is 0.2 mg/dL, and all preeclamptic labs are within normal limits. Fetal testing is reassuring. The provider diagnoses gestational hypertension. If the plan is to... Discharge the patient home; follow-up with weekly blood pressure checks, labs, and fetal testing. And then you find... The patient develops a headache unrelieved with acetaminophen. Then the initial plan becomes...
possibly invalidated
A 36-year-old G2P1001 at 31 weeks' gestation presents to her PCP's office with complaints of nausea and epigastric discomfort since she awoke this morning. She states that her husband has been sick with a stomach virus and has had similar symptoms. The nonstress test is reactive in the office. If the plan is to... Check preeclampsia laboratory tests. And then you find... The mother's blood pressure is 120/70 mm Hg. Then the initial plan becomes...
possibly invalidated
All of the following biochemical markers/laboratory tests can have value in evaluating patients with suspected preeclampsia, but which of these is NOT included in establishing the actual diagnosis?
put, creat, liver enzymes.. not uric acid?
A 34-year-old G1P0 at 28 weeks' gestation has a known history of chronic hypertension, which has been well-controlled on labetalol throughout the pregnancy. She presents with worsening hypertension to 150/100 mm Hg. Upon admission to the hospital, she is asymptomatic with normal maternal preeclamptic lab assessment and fetal testing. Her blood pressures are controlled with a small increase in her labetalol dosage. If you are considering a diagnosis of... An exacerbation of her pre-existing chronic hypertension. And then you find... On hospital day 2, the patient is complaining of new-onset headache unrelieved with acetaminophen. Then the initial diagnosis becomes...
strongly invalid?
A 36-year-old G1P0 at 32 weeks' gestation presents to labor and delivery with a 1-day history of new-onset headaches and worsening lower extremity edema over the preceding 2-3 weeks. Her blood pressure on presentation is 150/94 mm Hg, and a urine dipstick reveals trace protein. If the plan is to... Admit patient to the hospital for preeclampsia management. And then you find... Maternal platelet count is 110,000/microliter.
supported
HELLP syndrome is thought to be a variant of preeclampsia and is diagnosed by which of the following clinical findings? Select an answer. Hypertension Elevated creatinine Thrombocytopenia Minimal elevation of liver enzymes Headaches
thrombocytopenia
According to the recent American College of Obstetricians and Gynecologists guidelines, which of the following is a contraindication to expectant management (for up to 48 hours for full corticosteroid benefit) of preeclampsia with severe features?
uncontrollable hypertension
A 24-year-old G2P1 presents for her first prenatal visit at 14 weeks. She states that she has a history of systemic lupus erythematosus, but it is not active presently. Her BP is 180/120 mm Hg. What are correct next steps? Select all that apply. Check cuff size and repeat BP within 15 minutes as you tell the prenatal care provider. Ask if she has white coat syndrome. Check the BP on the other arm. Immediately ask for an order for an antihypertensive.
white coat syndrome? check cuff? swap arms? noi idea wtf
