OB Ch 27

The nurse observes that eclampsia has developed in a pregnant client after starting magnesium sulfate therapy. What action does the nurse take? 1 Continue to administer magnesium sulphate per protocol 2 Administer regional anesthesia to the client 3 Administer calcium gluconate simultaneously 4 Prepare the clientfor immediate caesarean birth

Continue to administer magnesium sulphate per protocol The nurse needs to administer additional magnesium sulfate, because it will help in treating eclamptic seizures and preventing repeated seizures. Regional anesthesia is not recommended for eclamptic clients due to the risk of maternal complications. Calcium gluconate is administered as an antidote for magnesium toxicity. Immediate cesarean birth is a priority when the client is in shock after a trauma.

What signs in a pregnant preeclamptic client would indicate the invasion stage of the tonic-clonic seizures? Select all that apply. 1 Fixed eyes 2 Bloodshot eyes 3 Protruding eyes 4 Stertorous inhalation 5 Twitching of facial muscles

Fixed eyes Twitching of facial muscles If a pregnant client with preeclampsia is in the tonic-clonic convulsion stage, the nurse may observe signs such as fixed eyes and twitching of facial muscles. These signs last for only 2 to 3 seconds. Bloodshot eyes and protruding eyes are signs of the stage of contraction. Stertorous inhalation can be observed in the stage of convulsion but is not seen in the stage of invasion.

Which conditions during pregnancy can result in preeclampsia in the client? Select all that apply. 1 Genetic abnormalities 2 Dietary deficiencies 3 Abnormal trophoblast invasion 4 Cardiovascular changes 5 Maternal hypotension

Genetic abnormalities Dietary deficiencies Abnormal trophoblast invasion Cardiovascular changes Current theories consider that genetic abnormalities and dietary deficiencies can result in preeclampsia. Abnormal trophoblast invasion causes fetal hypoxia and results in maternal hypertension. Cardiovascular changes stimulate the inflammatory system and result in preeclampsia in the pregnant client. Maternal hypertension, and not hypotension, after 20 weeks of gestation is known as preeclampsia.

A pregnant client has a systolic blood pressure that exceeds 160 mm Hg. Which action should the nurse take for this client? 1 Monitor uterine contractions 2 Obtain a prescription for antihypertensive medications 3 Restrict intravenous and oral fluids to 125 ml per hour 4 Monitor fetal heart rate

Obtain a prescription for antihypertensive medications Systolic BP exceeding 160 mm Hg indicates severe hypertension in the client. The nurse should alert the health care provider and obtain a prescription for antihypertensive medications, such as nifedipine (Adalat) and labetalol hydrochloride (Normodyne). Oral and IV fluids are restricted when the client is at risk for pulmonary edema. Monitoring FHR and UCs is a priority when the client experiences a trauma, so that any complications can be addressed immediately.

The nurse observes that a pregnant client with gestational hypertension who is on magnesium sulfate therapy is prescribed nifedipine (Adalat). What action does the nurse take? 1 Evaluates the client's renal function test 2 Obtains a prescription for a change of drug 3 Reduces the nifedipine (Adalat) dose by 50% 4 Administers both medications simultaneously

Obtains a prescription for a change of drug Concurrent use of nifedipine (Adalat) and magnesium sulfate can result in skeletal muscle blockade in the client. Therefore the nurse needs to report immediately to the primary health care provider (PHP) and obtain a prescription for a change of drug. The nurse assesses the client's renal function to determine the risk for toxicity after administering any drug. However, it is not a priority in this case. Reducing the nifedipine (Adalat) dose is not likely to prevent the drug interaction in the client. The nurse does not administer both drugs simultaneously, because it may be harmful for the client.

The nurse finds diuresis, weight loss, and muscle atrophy in a pregnant client with mild preeclampsia. What could the nurse conclude from these findings? 1 The client was mostly on a liquid diet. 2 The client was on prolonged bed rest. 3 The client has developed HELLP syndrome. 4 The client is at risk for placental abruption.

The client was on prolonged bed rest. Prolonged bed rest in clients with preeclampsia may result in diuresis and fluid, electrolyte, and weight loss. Therefore the nurse advises the client to restrict activity instead of taking complete bed rest. A liquid diet may contribute to weight loss, but does not cause diuresis or muscle atrophy. HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP) in a client with preeclampsia. Vaginal bleeding will indicate placental abruption in the patient.

A nurse is monitoring a client's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding indicates a cause for concern? 1 Bilateral DTRs noted at 2+ 2 DTRs response has been noted at 1+ since onset of therapy 3 Positive clonus response elicited unilaterally 4 Client reports no pain upon examination of DTRs by nurse.

Positive clonus response elicited unilaterally

Which conditions does the nurse remain alert for in a pregnant client with preeclampsia? Select all that apply

Seizures Scotoma Cerebral edema Seizures may be seen due to the central nervous system irritability in the patient. Scotoma is a visual disturbance that is seen in a patient with preeclampsia due to arteriolar vasospasms and decreased blood flow to the retina. Cerebral edema is a neurologic complication associated with preeclampsia. Chronic hypertension is seen in pregnant clients before pregnancy and is not associated with preeclampsia. Renal disease is a risk factor that may cause preeclampsia in the client.

The nurse is preparing to administer intravenous magnesium sulfate to a client with preeclampsia. Meanwhile, the student nurse positions the client in a supine position, monitors the fetal heart rate (FHR), checks for baseline variability, and monitors for the absence of late decelerations. Which action by the student nurse needs correction? 1 Checking for baseline variability 2 Monitoring of the fetal heart rate (FHR) 3 Placing the client in a supine position 4 Monitoring for the absence of late decelerations

Placing the client in a supine position While caring for a pregnant client with preeclampsia and ineffective tissue perfusion, the nurse should place the client on her side, not in a supine position. This is done to maximize the uteroplacental blood flow and ensure efficient uteroplacental oxygenation. This intervention also helps decrease the client's blood pressure, promote diuresis, and prevents supine hypotension. The student nurse should check for baseline variability, monitor the fetal heart rate (FHR), and check for the absence of late decelerations. These interventions promote the safety of the fetus.

A nurse is monitoring a client's reflexes (DTRs) while receiving magnesium sulfate therapy for treatment of preeclampsia. Which assessment finding indicates a cause for concern? 1 Bilateral DTRs noted at 2+ 2 DTRs response has been noted at 1+ since onset of therapy 3 Positive clonus response elicited unilaterally 4 Client reports no pain upon examination of DTRs by nurse.

Positive clonus response elicited unilaterally Positive clonus response elicited unilaterally is a cause for concern, because it suggests a hyperactive response. Bilateral DTRs noted at 2+ would indicate a normal finding. Even though this finding indicates a sluggish or decreased response, this is unchanged since the initiation of therapy. The nurse would continue to monitor. Typically, there is no pain associated with determination of DTRs so this finding would be considered normal.

With regard to preeclampsia and eclampsia, nurses should be aware of what information? 1 Preeclampsia is a condition of the first trimester; eclampsia is a condition of the second and third trimesters Correct 2 Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain 3 The causes of preeclampsia and eclampsia are well documented 4 Severe preeclampsia is defined as preeclampsia plus proteinuria

Preeclampsia results in decreased function in such organs as the placenta, kidneys, liver, and brain Vasospasms diminish the diameter of blood vessels; this impedes blood flow to all organs. Preeclampsia occurs after week 20 of gestation and can run for the duration of the pregnancy. The causes of preeclampsia and eclampsia are unknown, although several have been suggested. Preeclampsia includes proteinuria; severe cases are characterized by greater proteinuria or any of nine other conditions

A pregnant client with gestational hypertension has very high blood pressure. The nurse learns that the gestational age of the fetus is 37 weeks. What is the best intervention to prevent complications in the client? 1 Instruct the client to stay on bed 2 Provide the client with a nutritious dietary plan 3 Prepare the client for induction of labor 4 Instruct the client to come next week

Prepare the client for induction of labor a gestational age of 37 weeks in a client with gestational hypertension and dangerously high blood pressure indicates that labor should be induced as soon as possible. After 37 weeks of gestation, there may be detrimental effects of gestational hypertension on the fetus. Bed rest may not help relieve high blood pressure and therefore is not beneficial to the fetus. Nutritious food is essential for the client throughout pregnancy irrespective of the fetus' gestational age, but not as important as inducing labor in this client at 37 weeks of gestation. Instructing the client to come next week may worsen the condition and may be fatal to the fetus.

Which finding in a urine specimen of a pregnant patient indicates the client has proteinuria? 1 Value of greater than or equal to 0.5+ protein in a dipstick testing 2 Protein concentration that is greater than 300 mg/24 hours 3 Concentration of greater than or equal to 1 g protein in a 24-hour urine collection 4 Protein concentration at 10 mg/dl in random urine specimen

Protein concentration that is greater than 300 mg/24 hours Proteinuria is determined from dipstick testing on a clean-catch or catheterized urine specimen or evaluation of a 24-hour urine collection. Protein concentration that is greater than 300 mg/24 hours in a 24-hour urine specimen indicates proteinuria. A concentration of greater than or equal to 5 g protein in a 24-hour urine collection will indicate severe preeclampsia. Protein concentration greater than 30 mg/dl in at least two random urine specimens collected at least 6 hours apart will indicate proteinuria. Value of greater than or equal to 1+ on dipstick measurement indicates proteinuria

What does the nurse assess to detect the presence of a hypertensive disorder in a pregnant client? Select all that apply.

Proteinuria Epigastric pain Presence of edema Blood pressure (BP) Proteinuria indicates hypertension in a pregnant client. Proteinuria is concentration ≥300 mg/24 hours in a 24-hour urine collection. The nurse needs to assess the client for epigastric pain, because it indicates severe preeclampsia. Hypertension is likely to cause edema or swollen ankles due to greater hydrostatic pressure in the lower parts of the body. Therefore the nurse needs to assess the client for the presence of edema. Accurate measurement of BP will help detect the presence of any hypertensive disorder. A systolic BP >140 mm Hg or a diastolic BP >90 mm Hg will indicate hypertension. Placenta previa is a condition wherein the placenta is implanted in the lower uterine segment covering the cervix, which causes bleeding when the cervix dilates.

The nurse is caring for a client who gave birth vaginally two days ago. The nurse finds that the client has a blood pressure of 160/105 mm Hg. For what complications does the nurse monitor the client to ensure her safety? Select all that apply. 1 Renal failure 2 Hypovolemia 3 Liver damage 4 Brain damage 5 Pulmonary edema

Renal failure Pulmonary edema A blood pressure reading of 160/105 mm Hg two days after delivery indicates chronic hypertension. The nurse should closely monitor the client for complications of chronic hypertension such as renal failure, pulmonary edema, and hypertensive encephalopathy. Hypovolemia does not occur in chronic hypertension. In fact, hypertension is associated with edema, resulting in hypervolemia. Liver damage may not be directly caused by chronic hypertension. Brain damage may also not be a direct complication of chronic hypertension after delivery.

The nurse is caring for a client with preeclampsia who is receiving an intravenous (IV) magnesium sulfate (Sulfamag) infusion. The nurse assesses the client every 20 minutes. Which maternal findings require immediate intervention by the nurse? 1 Deep tendon reflex of 2+ 2 Urinary output of 30 ml/hr 3 Blood pressure of 130/90 mm Hg 4 Respiratory rate of 9 breaths/minute

Respiratory rate of 9 breaths/minute While caring for a pregnant client with preeclampsia on IV magnesium sulfate infusion therapy, the nurse should report a respiratory rate below 12 breaths per minute to the primary health care provider. Magnesium sulfate (Sulfamag) has the potential to decrease the respiratory rate. Any respiratory rate less than 12 breaths/minute in this client indicates decreased respiration and should be reported to the primary health care provider. A deep tendon reflex of 2+ is an expected response and a normal finding in the client. Urinary output of 30 ml/hr and blood pressure of 130/90 mm Hg are also normal findings. These conditions need not to be reported to the primary health care provider.

Which intervention will help prevent the risk of pulmonary edema in a pregnant client with severe preeclampsia? 1 Assess fetal heart rate (FHR) abnormalities regularly. 2 Place the client on bed rest in a darkened environment. 3 Restrict total intravenous (IV) and oral fluids to 125 ml/hr. 4 Ensure that magnesium sulfate is administered as prescribed.

Restrict total intravenous (IV) and oral fluids to 125 ml/hr. Pulmonary edema may be seen in clients with severe preeclampsia. Hence the nurse needs to restrict total intravenous (IV) and oral fluids to 125 ml/hr. FHR monitoring helps to assess any fetal complications. The client is placed on bed rest in a darkened environment to prevent stress. Magnesium sulfate is administered to prevent eclamptic seizures.

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if what happens? 1 Blood pressure is reduced to prepregnant baseline 2 Seizures do not occur 3 Deep tendon reflexes become hypotonic 4 Diuresis reduces fluid retention

Seizures do not occur Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures. A temporary decrease in blood pressure can occur; however, this is not the purpose of administering this medication. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration

A client with gestational hypertension is prescribed labetalol hydrochloride (Normodyne) therapy, which is continued after giving birth. What does the nurse instruct the client about breastfeeding? 1 "You may breastfeed the infant if you desire." 2 "Breastfeeding may cause convulsions in the infant." 3 "Breastfeed only once a day and use infant formulas." 4 "There may be high levels of the drug in the breast milk."

You may breastfeed the infant if you desire." Labetalol hydrochloride (Normodyne) has a low concentration in breast milk so the client can breastfeed the infant. Breastfeeding is safe and will not cause convulsions or any side effects in the infant. Infant formulas are used only if the mother is unable to breastfeed the infant or if the mother does not desire breastfeeding.

A nurse caring for pregnant women must be aware that what situation is the most common medical complication of pregnancy? 1 Hypertension 2 Hyperemesis gravidarum 3 Hemorrhagic complications 4 Infections

Hypertension

Which condition can be predicted in a pregnant client if uterine artery Doppler measurements in the second trimester of pregnancy are abnormal? 1 Preeclampsia 2 HELLP syndrome 3 Molar pregnancy 4 Gestational hypertension

Preeclampsia Preeclampsia is a condition in which clients develop hypertension and proteinuria after 20 weeks of gestation. It can be predicted if uterine artery Doppler measurements in the second trimester of pregnancy are abnormal. HELLP syndrome is characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP) in a patient with preeclampsia. Molar pregnancy refers to the growth of the placental trophoblast due to abnormal fertilization. Gestational hypertension is a condition in which hypertension develops in a client after 20 weeks of gestation.

A pregnant client with severe preeclampsia who is being transported to a tertiary care center needs to be administered magnesium sulfate injection for seizure activity. What actions does the nurse take when administering the drug? Select all that apply. 1 A 10-g dose is administered in the buttock. 2 A local anesthetic is added to the solution. 3 The Z-track technique is used to inject the drug. 4 The injection site is massaged after the injection. 5 The subcutaneous route is used to inject the drug.

A local anesthetic is added to the solution. The Z-track technique is used to inject the drug. The injection site is massaged after the injection The nurse adds a local anesthetic to the solution to reduce pain that is caused by the injection. The Z-track technique is used to inject the drug so that the drug is injected in the intramuscular (IM) tissue safely. The nurse gently massages the site after administering the injection to reduce pain. The nurse administers two separate injections of 5 g in each buttock. Magnesium sulfate injections are administered in the IM layer and not the subcutaneous layer.

The nurse is caring for a postpartum client with preeclampsia. What teaching does the nurse give the client before discharge from the hospital? 1 "Return to the hospital if you have epigastric pain." 2 "Take an analgesic if you have epigastric pain." 3 "If you get a headache, relax. It will subside in a while." 4 "Get an eye exam done if you have blurred vision."

A postpartum client with preeclampsia may have Return to the hospital if you have epigastric pain." headache, visual disturbances, and epigastric pain. The epigastric pain may worsen the client's condition if left untreated, and therefore, the nurse should ask the client to return to the hospital or contact the health care provider. The client should not take analgesics unassisted because delaying the appropriate clinical treatment for the epigastric pain may worsen the symptoms of preeclampsia. The client should immediately report to the primary health care provider if she experiences headache and blurred vision, because these conditions may indicate worsening of the preeclampsia or indicate other reasons for concern.

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of what? 1 Eclamptic seizure 2 Rupture of the uterus 3 Placenta previa 4 Abruptio placentae

Abruptio placentae Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption).

Which is a priority nursing action when a pregnant client with severe gestational hypertension is admitted to the health care facility? 1 Prepare the client for cesarean delivery. 2 Administer intravenous (IV) and oral fluids. 3 Provide diversionary activities during bed rest. 4 Administer the prescribed magnesium sulfate.

Administer the prescribed magnesium sulfate The nurse administers the prescribed magnesium sulfate to the client to prevent eclamptic seizures. IV oral fluids are indicated when there is severe dehydration in the client. It is important to provide diversionary activities during bed rest, but it is secondary in this case. A client who has experienced a multisystem trauma is prepared for caesarean delivery, which increases the chance of maternal survival, if there is no evidence of a maternal pulse.

A client with severe gestational hypertension is prescribed hydralazine (Apresoline). What is a priority nursing intervention in this case? 1 Assess for visual disturbances. 2 Assess airway, breathing, and pulse. 3 Assess blood pressure frequently. 4 Prepare the patient for nonstress testing.

Assess blood pressure frequently. Hydralazine (Apresoline) is an antihypertensive medication. The nurse assesses the client's BP frequently, because a precipitous drop in BP can lead to shock and placental abruption. Visual disturbances are symptoms of severe preeclampsia, not a side effect of hydralazine (Apresoline). The nurse needs to assess airway, breathing, and pulse to stabilize a pregnant client after a convulsion. Nonstress testing is performed once or twice weekly to assess fetal well being.

A pregnant client at 30 weeks of gestation has preterm labor. The nurse understands that the preterm baby may be born with immature lungs. What medication would be administered to help in lung maturation? 1 Hydralazine (Apresoline) 2 Calcium gluconate (Kalcinate) 3 Low-dose aspirin (Anacin) 4 Betamethasone (Celestone

Betamethasone (Celestone The primary health care provider prescribes corticosteroids such as betamethasone (Celestone) to enhance fetal lung maturation for gestations less than 34 weeks. Hydralazine (Apresoline) is an antihypertensive, which is not used to develop fetal lungs. Calcium gluconate (Kalcinate) is used as an antidote for magnesium sulfate (Sulfamag) toxicity. Low-dose aspirin (Anacin) prevents preeclampsia but does not help develop the fetus' lungs.

The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms should the nurse expect to observe? Select all that apply. 1 Decreased urinary output and irritability 2 Transient headache and +1 proteinuria 3 Ankle clonus and epigastric pain 4 Platelet count of less than 100,000/mm3 and visual problems 5 Seizure activity and hypotension

Decreased urinary output and irritability Ankle clonus and epigastric pain Platelet count of less than 100,000/mm3 and visual problems Decreased urinary output and irritability are signs of severe eclampsia. Ankle clonus and epigastric pain are signs of severe eclampsia. Platelet count of less than 100,000/mm3 and visual problems are signs of severe preeclampsia. A transient headache and +1 proteinuria are signs of preeclampsia and should be monitored. Seizure activity and hyperreflexia are signs of eclampsia.

A pregnant client with eclampsia has developed convulsions. The nurse immediately elevates the head of the bed to prevent aspiration and turns the client onto her side. The nurse then assesses the status of the client's airway, breathing, and pulse. The nurse suctions the secretions from the glottis to clear the airway, inserts an oral airway tube, and administers oxygen at 10 L/min through a face mask. Finally, the nurse administers intravenous (IV) magnesium sulfate as ordered. Which intervention by the nurse needs correction? 1 Administering oxygen at 10 L/min via face mask 2 Suctioning secretions from the glottis to clear the airway 3 Elevating the head of the bed to prevent aspiration 4 Inserting an oral airway to ensure proper breathing

Elevating the head of the bed to prevent aspiration Immediately after a convulsion, the nurse should lower the head of the bed and turn the client onto her side to prevent aspiration of vomitus. The nurse should not elevate the head of the bed; hence this intervention needs correction. The nurse should administer oxygen at 10 L/min through a face mask to maintain the client 's respiratory rate. The nurse should suction the secretions from the glottis to clear the airway and should insert an oral airway to ensure unobstructed breathing.

The nurse is preparing a diet plan for a pregnant client with preeclampsia. What does the nurse include in the client's diet? Select all that apply. 1 Food with low fiber content 2 Four to five cups of coffee per day 3 Food with low sodium content 4 Food with high zinc content 5 Six to eight glasses of water per day

Food with low sodium content Food with high zinc content Six to eight glasses of water per day Patients with preeclampsia may have edema, which may worsen with excessive salt intake. Therefore, the diet plan of a pregnant client with preeclampsia should include not more than 1.5 gm of sodium per day. The diet plan should also include food with high zinc content to prevent anemia caused by preeclampsia. The patient should drink six to eight 8-ounce glasses (approximately a liter) of water per day to maintain adequate fluid in her body. A pregnant patient should consume fiber-rich food to prevent constipation. The pregnant client with preeclampsia should limit her caffeine intake and should not consume excessive coffee.

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/minute, respiratory rate 24 breaths/minute, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for what medication? 1 Hydralazine 2 Magnesium sulfate bolus 3 Diazepam 4 Calcium gluconate

Hydralazine Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.

The nurse is caring for a pregnant client with preeclampsia. The client reports severe and persistent epigastric pain. The primary health care provider orders a blood test. What result may indicate a worsening liver function? 1 Increased red blood cell levels 2 Decreased serum creatinine levels 3 Decreased platelet count 4 Increased liver transaminase levels

Increased liver transaminase levels If a pregnant client with preeclampsia reports severe and persistent epigastric pain, it often indicates impaired liver function. An increase in liver transaminases to twice the normal levels in the blood confirms liver damage. Preeclampsia is characterized by a decrease in red blood cells. An increase in serum creatinine levels indicates renal insufficiency and is not related to liver damage. A decreased platelet count does occur in preeclampsia, but this does not cause severe persistent epigastric pain. Epigastric pain is pathognomonic of liver damage.

Which of the following antihypertensive medications would cause a pregnant woman to have a positive Coombs test result? 1 Nifedipine (Procardia) 2 Methyldopa (Aldomet) 3 Labetalol Hydrochloride (Transdate) 4 Hydrazaline (Apresoline)

Methyldopa (Aldomet) positive Coombs test result can occur in about 20% of patients on Methyldopa (Aldomet). Nifedipine, labetalol hydrochloride and hydrazaline would not cause this effect.

What does the nurse include in the plan of care of a pregnant client with mild preeclampsia? Select all that apply. 1 Ensure prolonged bed rest. 2 Provide diversionary activities. 3 Encourage the intake of adequate fluids. 4 Restrict sodium and zinc in the diet. 5 Refer to Internet-based support group.

Provide diversionary activities. Encourage the intake of adequate fluids. Refer to Internet-based support group. Activity is restricted in clients with preeclampsia, so it is necessary to provide diversionary activities to such clients to prevent boredom. The nurse encourages the client to increase fluid intake to an adequate level (six to eight 8-ounce glasses of water per day) to enhance renal perfusion and bowel function. The nurse can suggest Internet-based support groups to reduce boredom and stress in the client. Clients need to restrict activity, but complete bed rest is not advised, because it may cause cardiovascular deconditioning, muscle atrophy, and psychologic stress. The client needs to include adequate zinc and sodium in the diet for proper fetal development

The primary health care provider orders magnesium sulfate (Sulfamag) for a pregnant client who is being transported to the tertiary care center. What actions does the nurse follow according to the protocol? Select all that apply.

Mix the drug with a local anesthetic agent. Administer 5 g to each buttock as a loading dose Administer 5 g as a maintenance dose alternately to each buttock.

Which laboratory values would present in a client diagnosed with preeclampsia? Select all that apply. 1 Hemoglobin 8g/dl 2 Platelet count of 75,000 3 LDH 100 units/L 4 Burr cells 5 BUN 25 mg/dl

Platelet count of 75,000 LDH 100 units/L BUN 25 mg/ Thrombocytopenia below 100,000 would be noted. An increase in LDH and an increase in BUN would be noted. Hemoglobin levels would be increased and this would be a decreased level. Burr cells would not be present in preeclampsia but would be present with HELLP syndrome.

The nurse is caring for a preterm baby in the neonatal intensive care unit (NICU) who was born to a mother with preeclampsia. The family is anxious about the baby. What nursing interventions can help relieve anxiety in the family? Select all that apply.

mother with preeclampsia has an increased risk of preterm birth. The infant born in such a case may need to be cared for in a neonatal intensive care unit. The nurse can reduce the anxiety of the family members by providing photographs of the baby. This intervention assures them of the baby's well-being and acts as a psychologic relief to the anxious family. The nurse should encourage the partner of the baby to visit the NICU, which facilitates bonding and attachment with the baby. Informing family members about the baby's status helps relieve the family's anxiety. The nurse should not hand the baby over to the family for some time, because it may expose the baby to infections and compromise his or her health. The nurse should not arrange the mother's bed beside the baby. Instead, the mother can be taken to the NICU with the help of a wheelchair once her condition is stabilized

The nurse is caring for a pregnant client with chronic hypertension. What additional complication is most likely to be seen in this client?

Superimposed preeclampsia The pregnant client suffering from chronic hypertension has a high risk of developing superimposed preeclampsia. Eclampsia is caused by the progression of preeclampsia and causes complications such as seizures, but it is not directly associated with chronic hypertension. Preeclampsia is the condition of high blood pressure, with or without proteinuria. Gestational diabetes is not directly caused by chronic hypertension.

The nurse is caring for a client with preeclampsia who gave birth by cesarean section. The primary health care provider prescribes a nonsteroidal antiinflammatory pain medication to the client. What parameter does the nurse closely monitor in this client? 1 White blood cell (WBC) count 2 Respiratory rate 3 Blood pressure 4 Prothrombin time

Blood pressure Nonsteroidal antiinflammatory drugs should be used with caution in clients with preeclampsia. Because preeclampsia is associated with hypertension, these medications may have the potential to further increase such clients' blood pressure. Therefore, the nurse should closely monitor the client's blood pressure. White blood cells are unaffected by nonsteroidal antiinflammatory drugs, and monitoring the WBC count is not required. Monitoring the respiratory rate is essential in preeclampsia associated with seizures and is unrelated to the use of nonsteroidal antiinflammatory drugs. The prothrombin time is usually unchanged in preeclampsia and is not a complication of the administration of nonsteroidal antiinflammatory drugs.

Which hypertensive disorders can occur during pregnancy? Select all that apply.

Chronic hypertension Preeclampsia-eclampsia Gestational hypertension Chronic hypertension refers to hypertension that developed in the pregnant patient before 20 weeks of gestation. Preeclampsia refers to hypertension and proteinuria that develops 20 weeks after gestation. Eclampsia is the onset of seizure activity in a pregnant patient with preeclampsia. Gestational hypertension is the onset of hypertension after 20 weeks of gestation. Gestational trophoblastic disease and hyperemesis gravidarum are not hypertensive disorders. Gestational trophoblastic disease refers to a disorder without a viable fetus that is caused by abnormal fertilization. Hyperemesis gravidarum is excessive vomiting during pregnancy that may result in weight loss and electrolyte imbalance.

The nurse is caring for a hypertensive pregnant client who is on magnesium sulfate therapy. The nurse finds that the client has drowsiness, slurred speech, and depressed respiration. What medication would help in treating magnesium toxicity? 1 Intravenous diazepam (Valium) 2 Intravenous nifedipine (Adalat) 3 Intravenous hydralazine (Apresoline) 4 Intravenous calcium gluconate (Kalcinate

Intravenous calcium gluconate (Kalcinate) When treating a hypertensive pregnant client with magnesium sulfate therapy, the nurse should be alert for possible magnesium toxicity. Manifestations of magnesium toxicity include drowsiness, lethargy, slurred speech, depressed respiration, loss of deep tendon reflexes, and in severe cases, cardiac arrest. The effects of magnesium toxicity can be reversed by administering calcium gluconate (Kalcinate) intravenously. Diazepam (Valium) is an anticonvulsant drug; it is not used to reverse the effects of magnesium toxicity. Nifedipine (Adalat) is an antihypertensive drug; if used along with magnesium sulfate, it leads to muscle blockade. Hydralazine (Apresoline) is an antihypertensive drug; it does not reverse the symptoms of magnesium toxicity

What instruction does the nurse provide to a pregnant client with mild preeclampsia? 1 "You need to be hospitalized for fetal evaluation." 2 "Nonstress testing can be done once every month." 3 "Fetal movement counts need to be evaluated daily." 4 "Take complete bed rest during the entire pregnancy."

Fetal movement counts need to be evaluated daily." Preeclampsia can affect the fetus and may cause fetal growth restrictions, decreased amniotic fluid volume, abnormal fetal oxygenation, low birth weight, and preterm birth. Therefore the fetal movements need to be evaluated daily. Clients with mild preeclampsia can be managed at home effectively and need not be hospitalized. Nonstress testing is performed once or twice per week to determine fetal wellbeing. Clients need to restrict activity, but complete bed rest is not advised, because it may cause cardiovascular deconditioning, muscle atrophy, and psychologic stress.

What are the manifestations of HELLP syndrome? Select all that apply.

Hemolysis Low platelet count Elevated liver enzymes HELLP syndrome is a serious condition that may develop during pregnancy in a client with preeclampsia. It is characterized by hemolysis due to the breakdown of red blood cells. The client may have a low platelet count, increasing the risk of bleeding and elevated liver enzymes due to impaired functioning of the liver. HELLP is not associated with an increase in heart rate, and may not result in tachycardia. The pulmonary functioning is not impaired in the client with HELLP syndrome. Therefore, hyperventilation is not a manifestation of HELLP syndrome.

A client gains excessive weight during pregnancy, her laboratory reports reveal low levels of placental growth factors, and she is expected to deliver during the colder months of the year. Which medication would help in reducing risk of preeclampsia in the patient? 1 Nifedipine (Adalat) 2 Low-dose aspirin (Anacin) 3 Magnesium sulfate (Sulfamag) 4 Vitamin C supplement (Vita-C)

Low-dose aspirin (Anacin) A nonobese client who gains excessive weight during pregnancy is at an increased risk of developing preeclampsia. The low levels of placental growth factor and expected delivery during colder months of the year also increase the risk for preeclampsia. Low-dose aspirin (Anacin) helps lower the risk of preeclampsia and maintain general health. Nifedipine (Adalat) is an antihypertensive drug, not highly effective in preventing preeclampsia. Magnesium sulfate (Sulfamag) is the drug of choice for treating eclamptic seizures and preventing repeated seizures. A vitamin C supplement (Vita-C) does not help prevent preeclampsia.

The nurse is caring for a postpartum client. The primary health care provider prescribes intravenous magnesium sulfate (Sulfamag). Which other medications does the nurse check for in the treatment regimen to ensure the client's safety? Select all that apply. 1 Narcotics 2 Diuretics 3 Analgesics 4 Calcium channel blockers 5 Central nervous system (CNS) depressants

Narcotics Calcium channel blockers Central nervous system (CNS) depressants To ensure the client's safety, the nurse should check the treatment regimen before administering intravenous magnesium sulfate (Sulfamag). This drug may synergize the action of drugs such as narcotics, calcium channel blockers, and CNS depressants. Therefore, narcotics, calcium channel blockers, and CNS depressants should be used with caution in a client undergoing intravenous magnesium sulfate (Sulfamag) treatment. Diuretics and analgesics are not affected by magnesium sulfate (Sulfamag). Therefore, checking for these medications before administering intravenous magnesium sulfate (Sulfamag) is not necessary

A pregnant client has a sudden onset of seizures during the 3rd trimester of pregnancy. After reviewing the client's medical history, the nurse learns that the client had hypertension and proteinuria since 21 weeks of gestation. What will the nurse infer from these findings? 1 The client has eclampsia. 2 The client has preeclampsia. 3 The client has chronic hypertension. 4 The client has gestational hypertension

The client has eclampsia Eclampsia is a serious complication of pregnancy that is associated with the sudden onset of seizures. Eclampsia is usually preceded by premonitory signs and symptoms, including headache, blurred vision, abdominal pain, and altered mental status. However, convulsions can appear suddenly and without warning in a seemingly stable woman with only minimally elevated blood pressure. Preeclampsia is a condition in which the client has hypertension and proteinuria after 20 weeks of gestation, but preeclampsia is not associated with seizures. If the client has hypertension for more than 12 weeks after delivery, it indicates that client has chronic hypertension. Gestational hypertension is not associated with onset of seizures and proteinuria. Therefore, the nurse would not infer that the client has gestational hypertension

The nurse is teaching a pregnant client how to recognize signs of preeclampsia and when to report to the primary health care provider. Which statements by the client indicate effective learning? Select all that apply. 1 "I should report if I see an increase in urinary output." 2 "I should report if a dipstick test shows proteinuria less than 1+." 3 "I should report if I experience blurred vision or headache." 4 "I should report if I feel a decrease in the baby's movements." 5 "I should sit and use my right arm to accurately measure my blood pressure."

"I should report if I experience blurred vision or headache." "I should report if I feel a decrease in the baby's movements." "I should sit and use my right arm to accurately measure my blood pressure." The pregnant client should report to the primary health care provider if she experiences blurred vision, dizziness, and headache. These are the common clinical signs of preeclampsia. The client should report to the primary health care provider if she observes fewer fetal movements per hour, because it may be indicative of fetal compromise due to preeclampsia. To obtain accurate recordings, the pregnant client should use her right arm while in a sitting position to measure her blood pressure. The pregnant client should report to the primary health care provider in case of decreased urinary output, because a decrease in the glomerular filtration rate leads to degenerative glomerular changes and oliguria. The pregnant client should inform the primary health care provider if a dipstick test shows the value of 1+ or more, because it indicates proteinuria, an important sign of preeclampsia.

Nurses should be aware that what is associated with HELLP syndrome? 1 Is a mild form of preeclampsia 2 Can be diagnosed by a nurse alert to its symptoms 3 Is characterized by hemolysis, elevated liver enzymes, and low platelets 4 Is associated with preterm labor but not perinatal mortality

Is characterized by hemolysis, elevated liver enzymes, and low platelets The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. HELLP syndrome is difficult to identify, because the symptoms often are not obvious. It must be diagnosed in the laboratory. Preterm labor is greatly increased and so is perinatal mortality.

A pregnant woman who is 18 weeks of gestation has an elevated blood pressure of 140/98. Past medical history reveals that the woman has been treated for hypertension. Based on this information, the how would the nurse would classify this patient? 1 Preeclamptic 2 Gestational hypertension 3 Superimposed preeclampsia 4 Eclamptic

Superimposed preeclampsia Because this client already has a medical history of hypertension and is now exhibiting hypertension prior to the 20th week, she would be considered to have superimposed preeclampsia. Eclampsia is the onset of seizure activity or coma in a woman with preeclampsia. This woman is not displaying seizure activity, so this is incorrect. Gestational hypertension occurs after the 20th week of pregnancy in a client who was previously normotensive. Even though the client has chronic hypertension, the fact that she is now pregnant indicates that she would be classified as having superimposed preeclampsia.