Question 1

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 would be:

Accepted Answer

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

Question 2

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

Accepted Answer

Magnesium sulfate 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 sulfate can increase the duration of labor. Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulfate therapy.

Question 3

Nurses should be aware that chronic hypertension:

Accepted Answer

Hypertension is present before pregnancy or diagnosed before 20 weeks of gestation and persists longer than 6 weeks postpartum. 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

In caring for an immediate postpartum client,you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder:

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 client. 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 5

Nurses should be aware that 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 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.

Question 6

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

Accepted Answer

Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ 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. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore the presence of edema is no longer considered diagnostic of preeclampsia.

Question 7

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:

Accepted Answer

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

Question 8

Women with 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 and/or partners may be the cause.

Question 9

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

Accepted Answer

Risk for injury to the fetus related to uteroplacental insufficiency is the most appropriate nursing diagnosis for this client scenario. Other diagnoses include risk to 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 10

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

Accepted Answer

If a client becomes eclamptic,the nurse should stay with him or her and call for help.Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the client's head to the side to prevent aspiration. Once the seizure has ended,it may be necessary to suction the client's mouth. Oxygen would be administered after the convulsion has ended.

Question 11

In planning care for women with preeclampsia,nurses should be aware that:

Accepted Answer

Induction of labor 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 for healthy pregnant women,although some authorities have suggested a diet high in protein. Women with severe preeclampsia should expect a cesarean delivery.

Question 12

A woman with severe preeclampsia has been receiving magnesium sulfate 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 calls the physician,anticipating an order for:

Accepted Answer

Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. 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 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.

Question 13

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:

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 14

What 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 occur with DIC.

Question 15

In caring for the woman with disseminated intravascular coagulation (DIC),what 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 client 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 16

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 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 client complains,"I'm so thirsty and warm." The nurse:

Accepted Answer

The client 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 preeclampsia. Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg.

Question 17

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 would you expect to observe/assess in this client?

Accepted Answer

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

Question 18

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

Accepted Answer

Preeclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women have nausea and vomiting,but a 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 19

Because pregnant women may need surgery during pregnancy,nurses should be aware that:

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 20

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the 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 laboratory results are indicative of:

Accepted Answer

HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia 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 preeclampsia.

Quiz 14: Pregnancy at Risk: Gestational Conditions