Deck 34: Hypertension in Pregnancy: Preeclampsia-Eclampsia

Question 1

A diagnosis of preeclampsia requires a finding of both gestational hypertension + proteinuria.

Answer 1

False

Question 2

You are a nurse practitioner comanaging the care of a 20-year-old woman at 36 weeks gestation with a diagnosis of preeclampsia without severe features in the outpatient setting. Her highest blood pressure was previously 144/86 but today she presents with a single blood pressure of 155/98. In addition to evaluating for preeclampsia with end-organ involvement, which of the following is the most appropriate immediate management plan?

A) Change her diagnosis to severe preeclampsia and transfer care for induction of labor.
B) Collect a 24-hour urine sample to assess proteinuria.
C) Order antihypertensives STAT and consult with your collaborating physician.
D) Recheck her blood pressure in 15 minutes and follow procedures for accurate blood pressure measurement.

Answer 2

D

Question 3

Outpatient management of stable, nonsevere preeclampsia before 37 weeks includes:

A) Ultrasounds to assess fetal growth every 3 weeks.
B) Modified bed rest to insure lower blood pressure.
C) Twice weekly antenatal testing to assess fetal well-being.
D) a and c
E) b and c

Answer 3

D

Question 4

Women with gestational hypertension are diagnosed with severe preeclampsia when either of the following symptoms develop except:

A) Intrauterine growth restriction
B) Pulmonary edema
C) Severe headache
D) Thrombocytopenia

Question 5

Gestational hypertension, nonsevere preeclampsia, severe preeclampsia, and eclampsia are considered to be gestational presentations along the same spectrum, meaning that a more mild presentation could evolve into a more severe presentation over time.

Question 6

A 27-year-old client who is pregnant with her second baby presents to care at 12 weeks. She reports that her mother and sister both had severe preeclampsia but her first pregnancy was uncomplicated. Which of the following is included in your management plan today?

A) Confirm medical history and discuss signs and symptoms of preeclampsia.
B) Order labs including a CBC, ALT/AST, serum creatinine, and 24-hour urine protein.
C) Recommend genetic screening to assess if she has increased risk for preeclampsia.
D) Start daily low-dose aspirin therapy.

Question 7

The nurse manager of the prenatal clinic is updating the clinic guidelines for accurately measuring blood pressure. Which of the following should not be included in the recommendations?

A) Assess for any recent consumption of caffeine or nicotine.
B) Ensure correct blood pressure cuff size (width of bladder 40% of circumference and 
encircle 80% of arm).
C) Instruct clients to sit quietly for 5 minutes prior and not talk during the measurement.
D) Place pregnant clients in side-lying position to maximize placental blood flow.

Question 8

A certified nurse-midwife is discharging M.P., a stable postpartum client, home from the hospital at 2 days postpartum. M.P. gave birth vaginally after being induced at 37 weeks for nonsevere preeclampsia. Which of the following should be included in the postpartum instructions?

A) M.P. should have her blood pressure rechecked at 72 hours postpartum.
B) M.P. should have her blood pressure rechecked at 7-10 days postpartum.
C) Both a and b.
D) Neither a nor b are correct.

Question 9

A client presents today for her 6-week routine postpartum visit. She gave birth vaginally to her first child after being induced at 38 weeks for severe preeclampsia. Which of the following is not true and therefore should not be included in education about her future health and pregnancies?

A) Advise her that a history of preeclampsia increases her lifelong cardiovascular risk.
B) Counsel to seek primary care and use antihypertensives as needed during the interpregnancy interval to reduce recurrent preeclampsia risk.
C) Encourage exclusive breastfeeding for at least 6 months to reduce the risk of recurrent preeclampsia.
D) Recommend low-dose aspirin in subsequent pregnancies to reduce risk of recurrent preeclampsia.

Question 10

The only known cure for preeclampsia is delivery of the fetus and placenta.

Question 11

M.S. is 36 weeks pregnant and at today's visit you decide to order laboratory tests to rule out preeclampsia. Which of the following tests would not be in the panel you ordered?

A) AST/ALT
B) CBC
C) Serum creatinine
D) Uric acid
E) 24-hour urine for protein

Question 12

A 29-year-old primagravida at 34 weeks gestation visits you in clinic today. Her baseline blood pressure at 11 weeks was 130/70. Today she states that she has had several headaches this week that were relieved by Tylenol. Her pregnancy has been uncomplicated, except 4 days ago when she had a blood pressure of 145/78 and a negative urine dip for protein. Her laboratory tests to rule out preeclampsia were normal at that time. Today her blood pressure is 144/90 and her urine dip has no protein.
12-1. The most likely diagnosis today related to these findings is:

A) Chronic hypertension
B) Chronic hypertension with superimposed preeclampsia
C) Gestational hypertension
D) Preeclampsia
E) Preeclampsia with severe features

Question 13

A 29-year-old primagravida at 34 weeks gestation visits you in clinic today. Her baseline blood pressure at 11 weeks was 130/70. Today she states that she has had several headaches this week that were relieved by Tylenol. Her pregnancy has been uncomplicated, except 4 days ago when she had a blood pressure of 145/78 and a negative urine dip for protein. Her laboratory tests to rule out preeclampsia were normal at that time. Today her blood pressure is 144/90 and her urine dip has no protein.
12-1. Which of the following would you include in your management plan for this patient today?

A) Administer corticosteroids to enhance fetal lung maturity
B) Begin biweekly antenatal testing (nonstress test and amniotic fluid index)
C) Prescribe baby aspirin to take once a day
D) Schedule for induction of labor at 36 weeks