Deck 27: Hypertensive Disorders in Pregnancy

Question 1

One of the most important components of the physical assessment of the pregnant client is the determination of blood pressure.Consistency in measurement techniques must be maintained to ensure that the nuances in variation of blood pressure (BP)readings are not the result of provider error.The nurse must be aware of which techniques are important in obtaining an accurate BP reading.Choose all that apply.

A)The client should be seated.
B)The client's arm should be placed at the level of the heart.
C)An electronic BP device should be used.
D)The cuff should cover a minimum of 60% of the upper arm.
E)The same arm should be used for every reading.

Answer 1

The client should be seated.
The client's arm should be placed at the level of the heart.
The same arm should be used for every reading.

Question 2

A woman with preeclampsia has a seizure.The nurse's primary duty during the seizure is to:

A)Insert an oral airway
B)Suction the mouth to prevent aspiration
C)Administer oxygen by mask
D)Stay with the client and call for help

Answer 2

Stay with the client and call for help

Question 3

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:

A)Eclamptic seizure
B)Rupture of the uterus
C)Placenta previa
D)Abruptio placentae

Answer 3

Abruptio placentae

Question 4

A woman with worsening preeclampsia is admitted to the hospital's labor and birth unit.The physician explains the plan of care for severe preeclampsia,including the induction of labor,to the woman and her husband.The nurse determines that the couple needs further information when the woman's husband says:

A)"I will help my wife use the breathing techniques that we learned in our childbirth classes."
B)"I will give my wife ice chips to eat during labor."
C)"Since we will be here for a while,I will call my mother so she can bring the two boys [2 years and 4 years of age] to visit their mother."
D)"I will stay with my wife during her labor,just as we planned."

Question 5

Magnesium sulfate is given to women with preeclampsia and eclampsia to:

A)Improve patellar reflexes and increase respiratory efficiency
B)Shorten the duration of labor
C)Prevent and treat convulsions
D)Prevent a boggy uterus and lessen lochial flow

Question 6

Hypertensive disorders of pregnancy contribute significantly to maternal and infant morbidity and mortality worldwide.Neonatal complications of hypertensive disorders in the mother include:

A)Intrauterine growth restriction (IUGR)and prematurity
B)Seizures and cerebral hemorrhage
C)Hepatic or renal dysfunction
D)Placental abruption and disseminated intravascular coagulation (DIC)

Question 7

Nurses should be aware that chronic hypertension:

A)Is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy
B)Is considered severe when the systolic blood pressure (BP)is greater than 140 mm Hg or the diastolic BP is greater than 90 mm Hg
C)Is general hypertension plus proteinuria
D)Can occur independently of or simultaneously with preeclampsia

Question 8

The antidote administered to reverse magnesium toxicity is ______________________.

Question 9

HELLP syndrome is associated with an increased risk for adverse perinatal outcomes,including (choose all that apply):

A)Placental abruption
B)Placenta previa
C)Renal failure
D)Cirrhosis
E)Maternal and fetal death

Question 10

Your client has been on magnesium sulfate for 20 hours for treatment of preeclampsia.She just delivered a viable infant girl 30 minutes ago.What uterine findings do you expect to observe or assess in this client?

A)Absence of uterine bleeding in the postpartum period
B)A fundus firm below the level of the umbilicus
C)Scant lochia flow
D)A boggy uterus with heavy lochia flow

Question 11

What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia?

A)Risk for injury to mother and fetus related to central nervous system (CNS)irritability
B)Risk for eclampsia
C)Risk for deficient fluid volume related to increased sodium retention secondary to administration of magnesium sulfate
D)Risk for increased cardiac output related to the use of antihypertensive drugs

Question 12

Preeclampsia is a unique disease process related only to human pregnancy.The exact cause of this condition continues to elude researchers.The American College of Obstetricians and Gynecologists has developed a comprehensive list of risk factors associated with the development of preeclampsia.Which client exhibits the greatest number of these risk factors?

A)A 30-year-old obese Caucasian with her third pregnancy
B)A 41-year-old Caucasian primigravida
C)An African-American client who is 19 years old and pregnant with twins
D)A 25-year-old Asian-American whose pregnancy is the result of donor insemination

Question 13

Your client is being induced because of her worsening preeclampsia.She is also receiving magnesium sulfate.It appears that her labor has not become active despite several hours of oxytocin administration.She asks the nurse,"Why is it taking so long?" The most appropriate response by the nurse is:

A)"The magnesium is relaxing your uterus and competing with the oxytocin.It may increase the duration of your labor."
B)"I don't know why it is taking so long."
C)"The length of labor varies for different women."
D)"Your baby is just being stubborn."

Question 14

A primigravida is being monitored in her prenatal clinic for preeclampsia.What finding concerns her nurse?

A)Blood pressure (BP)increase to 138/86 mm Hg
B)Weight gain of 0.5 kg during the past 2 weeks
C)A dipstick value of 3+ for protein in her urine
D)Pitting pedal edema at the end of the day

Question 15

The labor of a pregnant woman with preeclampsia is going to be induced.Before initiating the oxytocin (Pitocin)infusion,the nurse reviews the woman's latest laboratory test findings,which reveal a platelet count of 90,000,an elevated aspartate transaminase (AST)level,and a falling hematocrit.The nurse notifies the physician because the lab results are indicative of:

A)Eclampsia
B)Disseminated intravascular coagulation (DIC)
C)HELLP syndrome
D)Idiopathic thrombocytopenia

Question 16

In planning care for women with severe gestational hypertension,nurses should be aware that:

A)Induction of labor is likely,as near term as possible
B)If at home,the woman should be confined to her bed,even with mild gestational hypertension
C)A special diet low in protein and salt should be initiated
D)Vaginal birth is still an option,even in severe cases

Question 17

Women with mild gestational hypertension and mild preeclampsia can be safely managed at home with frequent maternal and fetal evaluation.Complete or partial bed rest is still frequently ordered by some providers.Which is not a complication of bed rest?

A)Thrombophlebitis
B)Psychologic stress
C)Fluid retention
D)Cardiovascular deconditioning

Question 18

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours.On assessment the nurse finds the following vital signs: temperature 37.3° C,pulse rate 88 beats/min,respiratory rate 10 breaths/min,blood pressure (BP)148/90 mm Hg,absent deep tendon reflexes,and no ankle clonus.The client complains,"I'm so thirsty and warm." The nurse:

A)Calls for a stat magnesium sulfate level
B)Administers oxygen
C)Discontinues the magnesium sulfate infusion
D)Prepares to administer hydralazine