Maternity Case 1 Olivia Jones (Core)

Which of the following findings in a patient's prenatal history would indicate to the nurse a risk for developing preeclampsia? (Select all that apply) a) Asian ethnicity b) Body mass index (BMI) less than 20 c) Low socioeconomic status d) First pregnancy e) African-American ethnicity - C,D,E Rationale: Risk factors include first pregnancy, low socioeconomic status, poor nutrition, obesity, and African-American ethnicity. Low BMI and Asian ethnicity are not risk factors for preeclampsia. While providing the discharge education for a pregnant woman with preeclampsia, the nurse would inform the patient that which fetal test will be done twice a week until the baby is born? A) Nonstress test B) Biophysical profile C) Fetal kick counts D) Lecithin-sphingomyelin (L/S) ratio - A Rationale:A nonstress test is done to assess fetal heart rate (FHR) reactivity to fetal movement and is an indicator of fetal well-being. A biophysical profile would be done if the nonstress test was nonreactive. Fetal kick counts are done daily by the patient. An L/S ratio is a measure of pulmonary maturity and not specific to care of the patient with preeclampsia. While conducting the physical assessment, the nurse notes edema of the patient's hands and feet. When the nurse applies finger pressure to the edematous area, it results in a 4 mm skin depression that disappears in 15 seconds. How would the nurse document this finding? A) 1+ pitting edema B) 2+ pitting edema C) 3+ pitting edema D) 4+ pitting edema - B Rationale:This finding exactly meets the criteria for 2+ pitting edema. The nurse recognizes that blood pressure measurement is lowest when the pregnant patient is in which position? a) Side lying b) Supine c) Sitting d) Standing - A Rationale:A side-lying position results in the lowest blood pressure measurements because it displaces the weight of the gravid uterus from the major vessels, decreasing resistance to blood flow. Which of the following is the best description of the presentation of preeclampsia? a) Hypertension with proteinuria, which develops after 20 weeks' gestation b) Hypertension with pedal edema, which develops after 20 weeks' gestation c) Hypertension with seizure activity after the 28th week of pregnancy d) Preexisting hypertension before pregnancy, with proteinuria developing before 20 weeks' gestation - A Rationale:Preeclampsia is a disorder of the second half of pregnancy. It is characterized by the presence of pregnancy-related hypertension and proteinuria. The presence of seizures changes the diagnosis to eclampsia. The patient's support person asks the nurse, "What kind of care will she need at home?" The nurse would tell the patient and support person that they need to monitor which of the following at home? (Select all that apply) a) Blood pressure twice a day b) Changes in fundal height c) Fetal movement d) Daily weight e) Oral temperature - A,C,D Rationale: Monitoring of blood pressure, weight changes, and fetal movement are all part of the plan of care for the patient with preeclampsia. Oral temperature would be monitored in a patient with ruptured membranes but does not need to be monitored for preeclampsia. Fundal height may increase as the fetus grows or may decrease as the fetus "drops" into the pelvis, and therefore is not a useful parameter at this point. While being prepared for discharge, the patient asks the nurse, "What signs would mean that my preeclampsia is getting worse?" Which of the following signs and symptoms are consistent with increased severity of preeclampsia? (Select all that apply) A) Rupture of membranes B) Headache C) Blurred vision D) Epigastric pain E) Dependent edema - B,C,D Rationale: Headache and blurred vision are associated with central nervous system irritability due to vasoconstriction. Epigastric pain is associated with decreased liver perfusion. These are signs associated with worsening of preeclampsia. Dependent edema is a normal discomfort of late pregnancy, and rupture of membranes is associated with the onset of labor.