Deck 27: Hypertensive Disorders

Question 1

Which statement most accurately describes the HELLP syndrome?

A) Mild form of preeclampsia
B) Diagnosed by a nurse alert to its symptoms
C) Characterized by hemolysis,elevated liver enzymes,and low platelets
D) Associated with preterm labor but not perinatal mortality

Answer 1

Characterized by hemolysis,elevated liver enzymes,and low platelets

Question 2

A woman experiencing severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours.The nurse assesses the client and documents the following findings: temperature of 37.1° C,pulse rate of 96 beats per minute,respiratory rate of 24 breaths per minute,BP of 155/112 mm Hg,3+ DTRs,and no ankle clonus.The nurse calls the provider with an update.The nurse should anticipate an order for which medication?

A) Hydralazine
B) Magnesium sulfate bolus
C) Diazepam
D) Calcium gluconate

Answer 2

Hydralazine

Question 3

The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion.Which new finding would give the nurse cause for concern?

A) Sleepy,sedated affect
B) Respiratory rate of 10 breaths per minute
C) Deep tendon reflexes (DTRs)of 2+
D) Absent ankle clonus

Answer 3

Respiratory rate of 10 breaths per minute

Question 4

A primigravida is being monitored at the prenatal clinic for preeclampsia.Which finding is of greatest concern to the nurse?

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

Question 5

Which statement best describes chronic hypertension?

A) Chronic hypertension is defined as hypertension that begins during pregnancy and lasts for the duration of the pregnancy.
B) Chronic hypertension is considered severe when the systolic BP is higher than 140 mm Hg or the diastolic BP is higher than 90 mm Hg.
C) Chronic hypertension is general hypertension plus proteinuria.
D) Chronic hypertension can occur independently of or simultaneously with preeclampsia.

Question 6

The nurse has evaluated a client with preeclampsia by assessing deep tendon reflexes (DTRs).The result is a grade of 3+.Which DTR response most accurately describes this score?

A) Sluggish or diminished
B) Brisk,hyperactive,with intermittent or transient clonus
C) Active or expected response
D) More brisk than expected,slightly hyperactive

Question 7

Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply. )

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

Question 8

Which neonatal complications are associated with hypertension in the mother?

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

Question 9

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

A) Potential for injury to mother and fetus,related to central nervous system (CNS)irritability
B) Potential for reduced gas exchange
C) Potential for inadequate fluid volume,related to increased sodium retention secondary to the administration of magnesium sulfate
D) Potential for increased cardiac output,related to the use of antihypertensive drugs

Question 10

Which intervention is most important when planning care for a client with severe gestational hypertension?

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) Special diet low in protein and salt should be initiated immediately.
D) Vaginal birth is still an option,even in severe cases.

Question 11

One of the most important components of the physical assessment of the pregnant client is the determination of blood pressure (BP).Which techniques are important in obtaining accurate BP readings? (Select 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.

Question 12

The client is being induced in response to 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 this taking so long?" What is the nurse's most appropriate response?

A) "Since the magnesium is competing with the oxytocin,your labor is slowed."
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 13

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 partner.Which statement by the partner leads the nurse to believe that the couple needs further information?

A) "I will help her use the breathing techniques that we learned in our childbirth classes."
B) "I will give her ice chips to eat during labor."
C) "Since we will be here for a while,I'll ask my mother,to bring our toddler to visit."
D) "I will stay with her during her labor,just as we planned."

Question 14

What is the most common medical complication of pregnancy?

A) Hypertension
B) Hyperemesis gravidarum
C) Hemorrhagic complications
D) Infections

Question 15

The labor of a pregnant woman with preeclampsia 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 mm³,an elevated aspartate aminotransaminase (AST)level,and a falling hematocrit.The laboratory results are indicative of which condition?

A) Eclampsia
B) Disseminated intravascular coagulation (DIC)syndrome
C) Hemolysis,elevated liver enzyme levels,and low platelet levels (HELLP)syndrome
D) Idiopathic thrombocytopenia

Question 16

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.Which clinical change does the nurse anticipate?

A) Eclamptic seizure
B) Rupture of the uterus
C) Placenta previa
D) Placental abruption

Question 17

Which client exhibits the greatest number of risk factors associated with the development of preeclampsia?

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

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 per minute,respiratory rate 10 breaths per minute,BP 148/90 mm Hg,absent deep tendon reflexes (DTRs),and no ankle clonus.The client complains,"I'm so thirsty and warm." What is the nurse's immediate action?

A) To call for an immediate magnesium sulfate level
B) To administer oxygen
C) To discontinue the magnesium sulfate infusion
D) To prepare to administer hydralazine

Question 19

A woman with preeclampsia has a seizure.What is the nurse's highest priority during a seizure?

A) To insert an oral airway
B) To suction the mouth to prevent aspiration
C) To administer oxygen by mask
D) To stay with the client and call for help