NUR 353 Exam 2 Questions with complete solution
A nurse is assessing a patient with preeclampsia who delivered 12 hours ago.
Which of the following assessments would indicate that the condition has not yet resolved?
a. blood pressure reading at prenatal baseline
b. adequate urinary output and no proteinuria
c. presence of 1-2+ deep tendon reflexes
d. patient complaints of blurred vision and headache
D
What type of stomach pain is experienced in preeclampsia?
Epigastric pain with right upper quadrant pain
What 3 diagnostic procedures are conducted to test for gestational hypertensive disorders?
1. Urine testing for proteinuria and creatinine clearance.
2. NST, CST, and BPP to assess fetal status
3. Doppler blood flow analysis to assess fetal well-being
Medication of choice to prevent seizures in the client who has eclampsia and severe
preeclampsia.
Magnesium sulface
List 5 manifestations of magnesium sulfate toxicity.
1. Absence of patellar deep tendon reflexes.
2. Urine output less than 30 mL/hr
3. RR less than 12/min
4. Decreased LOC
5. Cardiac dysrhythmias
What is the antidote for magnesium sulfate?
Calcium gluconate
A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for
seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all
that apply.)
a. RR less than 12/min
,b. Urinary output less than 30 mL/hr
c. Hyperreflexic deep-tendon reflexes
d. Decrease LOC
e. Flushing and sweating
ABD
List 6 client education points for managing gestational hypertensive disorders postpartum.
1. Maintain bed rest and encourage side-lying position.
2. Promote diversional activities, such as watching TV, visits from family or friends, and gentle
exercise
3. Avoid foods that are high in sodium
4. Avoid alcohol, tobacco, and caffeine intake
5. Drink 6-8 glasses of water a day
6. Maintain a dark environment to prevent seizures
Magnesium sulfate toxicity can cause what serious adverse effect?
Coma
How many values in the 3-hour GTT must be elevated for there to be a diagnosis of
gestational diabetes mellitus?
2 out of the 3
A nurse is completing the admission assessment of a client who is at 38 weeks gestation and
has severe preeclampsia.
Which one of the following findings is consistent with the diagnosis of severe preeclampsia?
a. Polyuria
b. Absence of clonus
c. Epigastric pain
d. Tachycardia
C
Why is magnesium sulfate is given to women with preeclampsia and eclampsia?
a. To improve patellar reflexes and increase respiratory efficiency
b. To prevent and treat convulsions
c. To decrease blood pressure readings
d. To prevent a boggy uterus and lessen lochial flow
,B
A nurse in a prenatal clinic is reviewing results from recent one-hour oral glucose tolerance
tests.
Which one of the 4 pregnant clients needs to be scheduled for a follow-up, diagnostic three-
hour glucose tolerance test?
a. One hour GTT result: 115 mg/dl
b. One hour GTT result: 95 mg/dl
c. One hour GTT result: 125 mg/dl
d. One hour GTT result: 160 mg/dl
D
A nurse is caring for a client at 30 weeks gestation who has just been diagnosed with
gestational diabetes.
The client has a lot of questions about the risks to her baby with GDM.
What is the best explanation by the nurse for why her fetus is at risk for macrosomia and
hypoglycemia at delivery?
a. To prevent macrosomia, you should only gain 11-20 lbs. total during this pregnancy.
b. When your blood sugar levels are too high, the insulin that you make can cross the placenta
and affect your baby's metabolism.
c. Extra sugar (glucose) can cross the placenta to your baby. This may cause your baby to gain
extra weight and to have sudden low blood glucose after birth.
d. Your baby may be born with diabetes.
C
What are three classic clinical manifestations of preeclampsia?
1. Proteinuria
2. Epigastric pain
3. Headaches
Pathophysiology of preeclampsia.
In a normal pregnancy, spiral arteries widen to improve perfusion to the placenta. In a
preeclamptic pregnancy, the spiral arteries do widen, but not nearly as much which decreases
blood flow to the placenta. Your brain perceives hypo perfusion, and your brain thinks that you
are bleeding out. Your brain is going to release vasoconstrictor hormones and try to redirect
that blood to vital organs, such as the heart, brain, lungs, etc. Your brain doesn't think of the
, baby as a vital organ. This vasoconstriction leads to an increase in blood pressure. Over time,
this increase in BP causes wear and tear in your blood vessels, leading to little holes in the
vessels. Your brain stimulates a lipoprotein to be released to try to repair the vessels, but they
are not able to. The lipoprotein leaks out from the vessels and into the intravascular space. The
proteins attract water which causes edema. Liver necrosis can occur long term due to the
initiation of the clotting cascade by the brain, causing hypoxia, then ischemia, then necrosis.
Hypertensive disorder of pregnancy whereby the woman has an elevated blood pressure at
140/90 mmHg or greater recorded on two different occasions at least 4 hours apart.
Proteinuria is absent.
Gestational hypertension
This occurs when expulsion of the products of conception occurs. Premature cervical
dilations. A cause of bleeding during pregnancy.
Cervical insufficiency
What length is considered a short cervix?
Less than 25 mm in length
True or false. Dehydration stimulates uterine contractions.
True
Client education for a pregnant woman experiencing cervical insufficiency. (3)
1. Client will be on activity restriction or bed rest.
2. Hydrate more, because dehydration stimulates uterine contractions.
3. Avoid intercourse, tampons, and douching. Anything that can be inserted into the vagina.
List two risk factors for cervical insufficiency.
1. History of cervical trauma (Cervical tears, excessive dilations, surgical procedures.)
2. Congenital structural defects
List four expected findings for cervical insufficiency.
1. Increase in pelvic pressure or urge to push.
2. Pink stained vaginal discharge or bleeding
3. Water may break
4. Miscarriage (Uterus contracts with the expulsion of the fetus)
Presence of cervical funneling
Beaking
A nurse is assessing a patient with preeclampsia who delivered 12 hours ago.
Which of the following assessments would indicate that the condition has not yet resolved?
a. blood pressure reading at prenatal baseline
b. adequate urinary output and no proteinuria
c. presence of 1-2+ deep tendon reflexes
d. patient complaints of blurred vision and headache
D
What type of stomach pain is experienced in preeclampsia?
Epigastric pain with right upper quadrant pain
What 3 diagnostic procedures are conducted to test for gestational hypertensive disorders?
1. Urine testing for proteinuria and creatinine clearance.
2. NST, CST, and BPP to assess fetal status
3. Doppler blood flow analysis to assess fetal well-being
Medication of choice to prevent seizures in the client who has eclampsia and severe
preeclampsia.
Magnesium sulface
List 5 manifestations of magnesium sulfate toxicity.
1. Absence of patellar deep tendon reflexes.
2. Urine output less than 30 mL/hr
3. RR less than 12/min
4. Decreased LOC
5. Cardiac dysrhythmias
What is the antidote for magnesium sulfate?
Calcium gluconate
A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for
seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all
that apply.)
a. RR less than 12/min
,b. Urinary output less than 30 mL/hr
c. Hyperreflexic deep-tendon reflexes
d. Decrease LOC
e. Flushing and sweating
ABD
List 6 client education points for managing gestational hypertensive disorders postpartum.
1. Maintain bed rest and encourage side-lying position.
2. Promote diversional activities, such as watching TV, visits from family or friends, and gentle
exercise
3. Avoid foods that are high in sodium
4. Avoid alcohol, tobacco, and caffeine intake
5. Drink 6-8 glasses of water a day
6. Maintain a dark environment to prevent seizures
Magnesium sulfate toxicity can cause what serious adverse effect?
Coma
How many values in the 3-hour GTT must be elevated for there to be a diagnosis of
gestational diabetes mellitus?
2 out of the 3
A nurse is completing the admission assessment of a client who is at 38 weeks gestation and
has severe preeclampsia.
Which one of the following findings is consistent with the diagnosis of severe preeclampsia?
a. Polyuria
b. Absence of clonus
c. Epigastric pain
d. Tachycardia
C
Why is magnesium sulfate is given to women with preeclampsia and eclampsia?
a. To improve patellar reflexes and increase respiratory efficiency
b. To prevent and treat convulsions
c. To decrease blood pressure readings
d. To prevent a boggy uterus and lessen lochial flow
,B
A nurse in a prenatal clinic is reviewing results from recent one-hour oral glucose tolerance
tests.
Which one of the 4 pregnant clients needs to be scheduled for a follow-up, diagnostic three-
hour glucose tolerance test?
a. One hour GTT result: 115 mg/dl
b. One hour GTT result: 95 mg/dl
c. One hour GTT result: 125 mg/dl
d. One hour GTT result: 160 mg/dl
D
A nurse is caring for a client at 30 weeks gestation who has just been diagnosed with
gestational diabetes.
The client has a lot of questions about the risks to her baby with GDM.
What is the best explanation by the nurse for why her fetus is at risk for macrosomia and
hypoglycemia at delivery?
a. To prevent macrosomia, you should only gain 11-20 lbs. total during this pregnancy.
b. When your blood sugar levels are too high, the insulin that you make can cross the placenta
and affect your baby's metabolism.
c. Extra sugar (glucose) can cross the placenta to your baby. This may cause your baby to gain
extra weight and to have sudden low blood glucose after birth.
d. Your baby may be born with diabetes.
C
What are three classic clinical manifestations of preeclampsia?
1. Proteinuria
2. Epigastric pain
3. Headaches
Pathophysiology of preeclampsia.
In a normal pregnancy, spiral arteries widen to improve perfusion to the placenta. In a
preeclamptic pregnancy, the spiral arteries do widen, but not nearly as much which decreases
blood flow to the placenta. Your brain perceives hypo perfusion, and your brain thinks that you
are bleeding out. Your brain is going to release vasoconstrictor hormones and try to redirect
that blood to vital organs, such as the heart, brain, lungs, etc. Your brain doesn't think of the
, baby as a vital organ. This vasoconstriction leads to an increase in blood pressure. Over time,
this increase in BP causes wear and tear in your blood vessels, leading to little holes in the
vessels. Your brain stimulates a lipoprotein to be released to try to repair the vessels, but they
are not able to. The lipoprotein leaks out from the vessels and into the intravascular space. The
proteins attract water which causes edema. Liver necrosis can occur long term due to the
initiation of the clotting cascade by the brain, causing hypoxia, then ischemia, then necrosis.
Hypertensive disorder of pregnancy whereby the woman has an elevated blood pressure at
140/90 mmHg or greater recorded on two different occasions at least 4 hours apart.
Proteinuria is absent.
Gestational hypertension
This occurs when expulsion of the products of conception occurs. Premature cervical
dilations. A cause of bleeding during pregnancy.
Cervical insufficiency
What length is considered a short cervix?
Less than 25 mm in length
True or false. Dehydration stimulates uterine contractions.
True
Client education for a pregnant woman experiencing cervical insufficiency. (3)
1. Client will be on activity restriction or bed rest.
2. Hydrate more, because dehydration stimulates uterine contractions.
3. Avoid intercourse, tampons, and douching. Anything that can be inserted into the vagina.
List two risk factors for cervical insufficiency.
1. History of cervical trauma (Cervical tears, excessive dilations, surgical procedures.)
2. Congenital structural defects
List four expected findings for cervical insufficiency.
1. Increase in pelvic pressure or urge to push.
2. Pink stained vaginal discharge or bleeding
3. Water may break
4. Miscarriage (Uterus contracts with the expulsion of the fetus)
Presence of cervical funneling
Beaking
