Hypertensive Disorders of Pregnancy

The nurse is caring for a client with preeclampsia. The client is receiving an intravenous (IV) infusion of magnesium sulfate. When gathering items to be available for the client, which highest priority item should the nurse obtain? 1. Tongue blade 2. Percussion hammer 3. Potassium chloride injection 4. Calcium gluconate injection

4. Calcium gluconate injection

The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of preeclampsia? Select all that apply. 1. Proteinuria 2. Hypertension 3. Low-grade fever 4. Generalized edema 5. Increased pulse rate 6. Increased respiratory rate

1, 2, 4

Answer true or false to the following questions 1. Developing high blood pressure during pregnancy always means you have preeclampsia 2. A woman's age affects her risk for this condition 3. One of the main treatments for preeclampsia is bed rest 4. Preeclampsia can cause seizures in pregnant women

1. False 2. True 3. True 4. True Rationales: 1. Having high blood pressure during pregnancy (gestational hypertension) doesn't necessarily mean you have preeclampsia. High blood pressure is only one symptom of preeclampsia. You may have several other possible warning signs. 2. Being a teenage mother or 35 years or older raises the risk for preeclampsia. So does a history of long-term (chronic) high blood pressure. 3. Your healthcare provider may recommend bed rest if your preeclampsia is mild and your baby is not developed enough to deliver. Bed rest usually means lying on your left side most of the time. You will also need to be watched closely. 4. Preeclampsia can lead to a condition called eclampsia. This is a life-threatening condition that causes seizures.

A home care nurse is visiting a pregnant client with a diagnosis of mild preeclampsia. What is the priority nursing intervention during the home visit? 1. Monitor for fetal movement. 2. Monitor the maternal blood glucose. 3. Instruct the client to maintain complete bed rest. 4. Instruct the client to restrict dietary sodium and any food items that contain sodium.

1. Monitor for fetal movement.

A maternity unit nurse is developing a plan of care for a client with severe preeclampsia who will be admitted to the nursing unit. The nurse should include which nursing intervention in the plan? 1. Restrict food and fluids. 2. Reduce external stimuli. 3. Monitor blood glucose levels. 4. Maintain the client in a supine position.

2. Reduce external stimuli.

Preeclampsia superimposed onto a woman with chronic hypertension a. Chronic hypertension b. Gestational hypertension c. Preeclampsia d. Superimposed preeclamspia

d. Superimposed preeclamspia

A client with severe preeclampsia is admitted to the maternity department. Which room assignment would be most appropriate for this client? 1. A private room across from the elevator 2. A semiprivate room across from the nurses' station 3. A private room two doors away from the nurses' station 4. A semiprivate room with another client who enjoys watching television

3. A private room two doors away from the nurses' station

The nurse is performing an assessment on a pregnant client with a diagnosis of severe preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis? 1. Enlargement of the breasts 2. Complaints of feeling hot when the room is cool 3. Periods of fetal movement followed by quiet periods 4. Evidence of bleeding, such as in the gums, petechiae, and purpura

4. Evidence of bleeding, such as in the gums, petechiae, and purpura

In a patient with preeclampsia, what signs and symptoms indicate that the patient has a high risk of experiencing a seizure due to central nervous system irritability? Select all that apply: A. You note bouncing of the foot when it is quickly dorsiflexed. B. Patellar and bicep deep tendon reflexes are graded 4+. C. Platelet count 200,000 D. Patient reports a decrease in headache pain.

A, B The answers are A and B. Option A indicates positive clonus and Option B is indicative of hyperreflexia. If these findings are present it demonstrates that the central nervous system is irritated and there is a high risk of potential seizure activity. Seizure precautions should be initiated and the physician notified.

A 37 week pregnant patient is admitted with severe preeclampsia. The patient begins to experiences a tonic-clonic seizure. Which of the following would the nurse AVOID during the seizure? [SATA] A. Placing the patient in a supine position B. Holding down the patient's head to prevent injury C. Staying with the patient and activating the emergency response team D. Timing the seizure E. Providing 8 to 10 L of oxygen

A, B The answers are A and B. The nurse would want to place the patient on their side (preferably the left-side...not supine) to help prevent the tongue from obstructing the airway, preventing aspiration, and improving blood flow to the placenta. In addition, the nurse would NOT want to restrain the patient, which can cause injury. Option C, D, and E are steps the nurse would want to take.

Select all the risk factors below that increases a woman's risk for developing preeclampsia: A. Primigravida B. BMI 34 C. Pregnant with twins D. Maternal history of preeclampsia E. Age: 25-years-old F. History of Lupus and Diabetes

A, B, C, D, F Risk factors for preeclampsia include: History of preeclampsia or family history, first pregnancy (primigravida), significant health history prior to pregnancy: diabetes, lupus, high blood pressure, kidney disease, Obese: BMI >30, having more than one baby (twins, triplets etc.), age (young <18 or advanced >35).

Your patient is 36 weeks pregnant with severe preeclampsia. The physician has ordered lab work to assess for HELLP Syndrome. Which findings on the patient's lab results correlate with HELLP Syndrome? A. Hemoglobin 12 g/dL B. Platelets 90,000 μL C. ALT 100 IU/L D. AST 90 IU/L E. Glucose 350 mg/dL F. Abnormal RBC peripheral smear

B, C, D, F The answers are: B, C, D, and F. HELLP Syndrome causes of Hemolysis of RBCs (abnormal RBC peripheral smear), Elevated Liver enzymes (>70 IU/L for AST or ALT), Low Platelets (<100,000 μL ).

A patient is currently 34 weeks pregnant with her first baby. Which findings below could indicate the development of preeclampsia in this patient that would need to be reported to the physician? Select all that apply: A. 1600: blood pressure 144/100, 1700: blood pressure 120/80 B. 3+ dipstick urine protein C. 1 hour glucose tolerance test 90 mg/dL D. 0800: blood pressure 142/92, 1230: blood pressure: 144/98 E. <300 mg/dL 24-hour urine protein

B, D The answers are B and D. Signs and symptoms of preeclampsia include: proteinuria (>1+ dipstick urine protein or >300 mg/dL 24 hour urine protein, hypertension >140/90...two reading at least 4-6 hours apart), swelling in face, eyes, extremities, headaches, vision changes, etc.

A 37-year-old female patient who is 36 weeks pregnant is diagnosed with mild preeclampsia. The nurse will include what information in the patient's education? Select all that apply: A. Report weight gain of >4 lbs in one week to physician B. Incorporate foods like eggs, nuts, fish, meat in your diet C. Follow a no salt diet D. Headache and vision changes are expected side effects of this condition and cause no reason for concern. E. Importance of monitoring urine protein at home F. Lying on left-side is recommended along with rest G. Report a decrease in fetal activity immediately

B, E, F, G The answers are: B, E, F, and G. These options are topics the nurse wants to include in the patient's teaching with preeclampsia. Option A is wrong because the patient should report a weight gain of >2 lbs (NOT 4 lbs) in one week. Option C is wrong become it is no longer recommended the patient restrict salt in diet but limit it. Option D is wrong because a headache and vision changes are serious complications that may indicate the development of eclampsia, and the patient should report it immediately.

How would the nurse check for clonus in a patient with preeclampsia? A. Assess the patellar and bicep tendon with a reflex hammer and grade the reaction. B. Assess for muscular rigidity by having the patient extend the arms and place resistance against the arms. C. Assess for beating of the foot when the foot is quickly dorsiflexed. D. Assess for dorsiflexion of the foot by quickly plantar flexing the foot.

C. Assess for beating of the foot when the foot is quickly dorsiflexed. The answer is C: To check for clonus the nurse will have the patient dangle the leg and support the patient's lower leg. Then the nurse will quickly dorsiflex the foot. The nurse is assessing for bouncing or beating of the foot (hence the foot attempts to plantarflex). If the foot attempts to bounce or beat 3 or more times, it is positive for clonus.

The nurse knows that preeclampsia tends to occur during what time in a pregnancy? A. before 20 weeks B. in the third trimester and postpartum C. after 20 weeks D. in the first and second trimester

C. after 20 weeks

Your patient with preeclampsia is started on Magnesium Sulfate. The nurse knows to have what medication on standby? A. Acetylcysteine B. Calcium carbonate C. Oxytocin D. Calcium gluconate

D. Calcium gluconate The answer is D: The antidote for Magnesium Sulfate is Calcium Gluconate. The nurse should have this on hand in case Magnesium toxicity occurs.

What is the cure for preeclampsia?

Delivery

Preeclampsia with seizures would be described as

Eclampsia

TRUE/FALSE: Following placental delivery, seizure precautions should be discontinued in the preeclamptic mother since the baby and placenta have been delivered

False. Seizures can still occur up to 48 hours postpartum

What are the characteristics of HELLP syndrome?

Hemolysis Elevated Liver enzymes Low Platelet count

Based on a known history of hypertension prior to pregnancy, hypertension that is discovered during the pregnancy prior to 20 weeks' gestation, or hypertension that persists for more than 12 weeks postpartum a. Chronic hypertension b. Gestational hypertension c. Preeclampsia d. Superimposed preeclamspia

a. Chronic hypertension

Which of the following medications may be prescribed for a woman who has been identified to be at risk for developing preeclampsia and HELLP syndrome? a. Low dose aspirin b. Methylernogonovine c. Bupropion d. Calcium gluconate

a. Low dose aspirin "Women with chronic hypertension or a history of preeclampsia in prior pregnancies should be placed on a low-dose aspirin regimen" Pearson 1264

Which of the following would be identified as early signs of preeclampsia? [SATA] a. Vision changes b. High blood pressure c. Proteinuria d. Decreased urine output

b, c While a and d are signs of preeclampsia, they are more severe symptoms that are seen as preeclampsia progresses.

Nonstress tests, biophysical profiles, and ultrasounds should be performed how often during the third trimester for the preeclamptic mother? a. Weekly b. Biweely c. Every three weeks d. Every four weeks

b. Biweekly

Occurs in the second half of pregnancy in a previously normotensive mother. Diagnosis is made when BP is greater than or equal to 140/90 mmHg on two occasions that are at least 6 hours apart after 20 weeks gestation. a. Chronic hypertension b. Gestational hypertension c. Preeclampsia d. Superimposed preeclamspia

b. Gestational hypertension

The most common medical disorder among pregnant women. a. Gestational diabetes b. Hypertension c. Diabetes insipidus d. Postural hypotension

b. Hypertension One of the major causes of pregnancy related deaths in the United States. Said to complicate up to 1 in 10 pregnancies and affects 240,000 women in the US each year.

In a preeclamptic mother, which of the following medications may be administered prior to 34 weeks gestation to enhance fetal lung maturity? a. Methylernogonovine b. Albuterol c. Beclomethasone d. Terbutaline

c. Beclomethasone Beclomethasone is a corticosteroid, these drugs are used to enhance fetal lung maturity prior to 34 weeks

Defined according to the same criteria as gestational hypertension, accompanied by signs of end organ damage. Can lead to eclampsia, which is this but with seizures a. Chronic hypertension b. Gestational hypertension c. Preeclampsia d. Superimposed preeclamspia

c. Preeclampsia

What is the first sign of magnesium toxicity? a. Respiratory depression b. Adventitious lung sounds c. Decreased oxygen saturation d. Loss of deep tendon reflexes

d. Loss of deep tendon reflexes