Lowdermilk 11th Ed. Chapter 27: Hypertensive Disorders Practice Exam Test.

Lowdermilk 11th Ed. Chapter 27: Hypertensive Disorders Practice Exam Test. 1. 1. A primigravida is being mon- C (Proteinuria is defined as a concentration of 1+ or greater via itored at the prenatal clinic for preeclampsia. Which find- ing is of greatest concern to the nurse? dipstick measurement. A dipstick value of 3+ alerts the nurse that additional testing or assessment should be performed. A 24-hour urine collection is preferred over dipstick testing attributable to accuracy. Generally, hypertension is defined as a BP of 140/90 mm Hg or an increase in systolic pressure of a. Blood pressure (BP) increase 30 mm Hg or diastolic pressure of 15 mm Hg. Preeclampsia to 138/86 mm Hg may be demonstrated as a rapid weight gain of more than 2 b. Weight gain of 0.5 kg during kg in 1 week. Edema occurs in many normal pregnancies, as the past 2 weeks c. Dipstick value of 3+ for pro- tein in her urine d. Pitting pedal edema at the end of the day 2. 2. 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 mm3, an elevated aspartate amino- transaminase (AST) level, and a falling hematocrit. The labo- ratory results are indicative of which condition? a. Eclampsia well as in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia. DIF: Cognitive Level: Analyze REF: p. 660 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity) C (HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction char- acterized by hemolysis (H), elevated liver (EL) enzymes, 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. DIF: Cognitive Level: Understand REF: p. 657 TOP: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity) b. Disseminated intravascular coagulation (DIC) syndrome c. Hemolysis, elevated liver en- zyme levels, and low platelet levels (HELLP) syndrome d. Idiopathic thrombocytope- nia 3. 3. A woman with preeclamp- sia has a seizure. What is the nurse's highest priority during a seizure? a. To insert an oral airway D (If a client becomes eclamptic, then the nurse should stay with the client and call for help. Nursing actions during a convulsion are directed toward ensuring a patent airway and client safety. 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 b. To suction the mouth to pre- side to prevent aspiration. Once the seizure has ended, it vent aspiration c. To administer oxygen by mask d. To stay with the client and call for help 4. 4. 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 vi- may be necessary to suction the client's mouth. Oxygen is administered after the convulsion has ended. DIF: Cognitive Level: Apply REF: p. 666 TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity) C (Regardless of the magnesium level, the client is displaying the clinical signs and symptoms of magnesium toxicity. The first action by the nurse should be to discontinue the infusion of magnesium sulfate. In addition, calcium gluconate, the an- tidote for magnesium, may be administered. Hydralazine is an antihypertensive drug commonly used to treat hypertension in tal signs: temperature 37.3° C, severe preeclampsia. Typically, hydralazine is administered for pulse rate 88 beats per minute, a systolic BP higher than 160 mm Hg or a diastolic BP higher respiratory rate 10 breaths per than 110 mm Hg. 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 magne- sium sulfate infusion d. To prepare to administer hy- dralazine 5. 5. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences in- creased contraction frequen- cy of every 1 to 2 min- utes, dark red vaginal bleed- ing, and a tense, painful ab- domen. Which clinical change does the nurse anticipate? DIF: Cognitive Level: Apply REF: p. 664 TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity)