Question 1

A woman at 39 weeks of gestation with a history of pre-eclampsia is admitted to the labour 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 which of the following?

Accepted Answer

Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption).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.

Question 2

Your patient is being induced because of her worsening pre-eclampsia.She is also receiving magnesium sulphate.It appears that her labour has not become active,despite several hours of oxytocin administration.She asks the nurse,"Why is it taking so long?" What is the most appropriate response by the nurse?

Accepted Answer

Because magnesium sulphate is a tocolytic agent,its use may increase the duration of labour.The amount of oxytocin needed to stimulate labour may be more than that needed for the woman who is not receiving magnesium sulphate."I don't know why it is taking so long." is not an appropriate statement for the nurse to make.Although the length of labour does vary for different women,the most likely reason that this woman's labour is protracted is the tocolytic effects of magnesium sulphate.The behaviour of the fetus has no bearing on the length of labour.

Question 3

Which statement is true of pre-existing hypertension?

Accepted Answer

Pre-existing hypertension is present before pregnancy or diagnosed before 20 weeks of gestation and persists longer than 6 weeks postpartum.It can occur with pre-eclampsia as well as other comorbid conditions.The range for hypertension is systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg.It becomes severe with a diastolic BP of 110 mm Hg or higher.Proteinuria is an excessive concentration of protein in the urine.It is a complication of hypertension,not a defining characteristic.

Question 4

A woman with pre-eclampsia has a seizure.What is the nurse's priority intervention?

Accepted Answer

If a patient becomes eclamptic,the priority intervention is to ensure a patent airway.The nurse should attempt to keep the airway patent by turning the patient's head to the side to prevent aspiration.The nurse should stay with her and call for help,not to provide emotional support.Once the seizure has ended,it may be necessary to suction the patient's mouth.Oxygen would be administered after the convulsion has ended.

Question 5

A woman with severe pre-eclampsia has been receiving magnesium sulfphate by intravenous infusion for 8 hours.The nurse assesses the woman and documents the following findings: temperature of 37.1°C,pulse rate of 96 beats/min,respiratory rate of 24 breaths/min,blood pressure (BP)of 155/112 mm Hg,3+ deep tendon reflexes,and no ankle clonus.The nurse should anticipate a doctor's order for which of the following?

Accepted Answer

Hydralazine is an antihypertensive commonly used to treat hypertension in severe pre-eclampsia.Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg.An additional bolus of magnesium sulphate may be ordered for increasing signs of central nervous system irritability related to severe pre-eclampsia (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 sulphate toxicity.The patient is not currently displaying any signs or symptoms of magnesium toxicity.

Question 6

A primigravida is being monitored in her prenatal clinic for pre-eclampsia.Which finding should concern her nurse?

Accepted Answer

Proteinuria is defined as a concentration of 0.03 g/L or more in at least two random urine specimens and should alert the nurse that additional testing or assessment should be made.Generally,hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or 15 mm Hg diastolic pressure.Pre-eclampsia may manifest as a rapid weight gain of more than 2 kg in 1 week.Edema occurs in many normal pregnancies and in women with pre-eclampsia.Therefore,the presence of edema is no longer considered diagnostic of pre-eclampsia.

Question 7

Which statement is true about women who experience hyperemesis gravidarum?

Accepted Answer

Women with hyperemesis gravidarum have severe vomiting; however,treatment for several days sets things right in most cases.Although 70% of pregnant women experience nausea and vomiting,fewer than 1% proceed to this severe level.IV administration may be used at first to restore fluid levels,but they are seldom needed for very long.Women suffering from this condition want sympathy,because some authorities believe that difficult relationships with mothers or partners may be the cause.

Question 8

A woman with severe pre-eclampsia is receiving a magnesium sulphate infusion.Which finding should the nurse be concerned about?

Accepted Answer

A respiratory rate of 10 breaths/min indicates that the patient is experiencing respiratory depression from magnesium toxicity.Because magnesium sulphate is a central nervous system depressant,the patient will most likely become sedated when the infusion is initiated.Deep tendon reflexes of 2 and absent ankle clonus are normal findings.

Question 9

In caring for an immediate postpartum patient,you note petechiae and oozing from her IV site.Based on this assessment,what clotting disorder would the nurse monitor her closely for?

Accepted Answer

The diagnosis of DIC is made according to clinical findings and laboratory markers.Physical examination reveals unusual bleeding.Petechiae may appear around a blood pressure cuff on the woman's arm.Excessive bleeding may occur from the site of a slight trauma such as venipuncture sites.These symptoms are not associated with AFE,nor is AFE a bleeding disorder.Hemorrhage occurs for a variety of reasons in the postpartum patient.These symptoms are associated with DIC.Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself.HELLP is not a clotting disorder,but it may contribute to the clotting disorder DIC.

Question 10

What should the nurse be aware of in relation to women who may need surgery during pregnancy?

Accepted Answer

Both appendicitis and pregnancy are linked with nausea,vomiting,and increased white blood cell count.Rupture of the appendix is two to three times more likely in pregnant women.Surgery to remove obstructions should be done right away.It usually does not affect the pregnancy.Pregnancy predisposes a woman to ovarian problems.

Question 11

Which of the following is true in relation to HELLP syndrome?

Accepted Answer

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

Question 12

What nursing diagnosis would be most appropriate for a woman experiencing severe pre-eclampsia?

Accepted Answer

Risk for injury to the fetus related to uteroplacental insufficiency is the most appropriate nursing diagnosis for this patient scenario.Other diagnoses include risk to the fetus related to preterm birth and abruptio placentae.Eclampsia is a medical,not a nursing,diagnosis.There would be a risk for excess,not deficient,fluid volume related to increased sodium retention.There would be a risk for decreased,not increased,cardiac output related to the use of antihypertensive drugs.

Question 13

The labour of a pregnant woman with pre-eclampsia is going to be induced.Before initiating the oxytocin 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.These findings are indicative of which of the following?

Accepted Answer

HELLP syndrome is a laboratory diagnosis for a variant of severe pre-eclampsia that involves hepatic dysfunction characterized by hemolysis (H),elevated liver enzymes (EL),and low platelets (LP).Eclampsia is determined by the presence of seizures.DIC is a potential complication associated with HELLP syndrome.Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with pre-eclampsia.

Question 14

In planning care for women with pre-eclampsia,what should the nurse be aware of?

Accepted Answer

Induction of labour is likely,as near term as possible; however,at less than 37 weeks of gestation,immediate delivery may not be in the best interest of the fetus.Strict bed rest is becoming controversial for mild cases; some women in the hospital are even allowed to move around.Diet and fluid recommendations are much the same as those for healthy pregnant women,although some authorities have suggested a diet high in protein.Women with severe pre-eclampsia should expect a Caesarean delivery.

Question 15

The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is which of the following?

Accepted Answer

Pre-eclampsia and eclampsia are two noted deadly forms of hypertension.A large percentage of pregnant women have nausea and vomiting,but relatively few have the severe form called hyperemesis gravidarum.Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common.Hypertension is the most common medical complication of pregnancy.

Question 16

In caring for the woman with disseminated intravascular coagulation ( DIC ),which order should the nurse anticipate?

Accepted Answer

Primary medical management in all cases of DIC involves correction of the underlying cause,volume replacement,blood component therapy,optimization of oxygenation and perfusion status,and continued reassessment of laboratory parameters.Central monitoring would not be ordered initially in a patient with DIC because this can contribute to more areas of bleeding.Management of DIC would include volume replacement,not volume restriction.Steroids are not indicated for the management of DIC.

Question 17

Which laboratory marker is indicative of disseminated intravascular coagulation ( DIC )?

Accepted Answer

Degradation of fibrin leads to the accumulation of fibrin split products in the blood.Bleeding time in DIC is normal.Low platelets may occur with,but are not indicative of,DIC because they may result from other coagulopathies.Hypofibrinogenemia would not occur with DIC.

Question 18

Your patient has been on magnesium sulphate for 20 hours for treatment of pre-eclampsia.She just delivered a viable infant girl 30 minutes ago.What uterine findings would you expect to assess in this patient?

Accepted Answer

Because of the tocolytic effects of magnesium sulphate,this patient most likely would have a boggy uterus with increased amounts of bleeding and a heavy lochia flow in the postpartum period.

Question 19

What is the purpose of administering magnesium sulphate to women with pre-eclampsia and eclampsia?

Accepted Answer

Magnesium sulphate is the drug of choice to prevent convulsions,although it can generate other problems.Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity.Magnesium sulphate can increase the duration of labour.Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulphate therapy.

Question 20

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

Accepted Answer

The patient is displaying clinical signs and symptoms of magnesium toxicity.Magnesium should be discontinued immediately.In addition,calcium gluconate,the antidote for magnesium,may be administered.Hydralazine is an antihypertensive commonly used to treat hypertension in severe pre-eclampsia.Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg.

Quiz 13: Pregnancy at Risk: Gestational Conditions