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High Risk Pregnancy NCLEX Questions and Answers Graded A+

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A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. Which finding would the nurse interpret as indicating a therapeutic level of medication? A) Urinary output of 20 mL per hour B) Respiratory rate of 10 breaths/minute C) Deep tendons reflexes 2+ D) Difficulty in arousing - -Ans: C With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respirat

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High Risk Pregnancy NCLEX Questions and Answers Graded A+

A client is diagnosed with gestational hypertension and diarrhea. It does not cause gastrointestinal
and is receiving magnesium sulfate. Which finding bleeding, blurred vision, or sweating. Magnesium
would the nurse interpret as indicating a therapeutic sulfate may cause sweating.
level of medication?

A) Urinary output of 20 mL per hour After reviewing a client's history, which factor would
B) Respiratory rate of 10 breaths/minute the nurse identify as placing her at risk for gestational
C) Deep tendons reflexes 2+ hypertension?
D) Difficulty in arousing - -Ans: C
A) Mother had gestational hypertension during
With magnesium sulfate, deep tendon reflexes of 2+ pregnancy.
would be considered normal and therefore a B) Client has a twin sister.
therapeutic level of the drug. Urinary output of less C) Sister-in-law had gestational hypertension.
than 30 mL, a respiratory rate of less than 12 D) This is the client's second pregnancy. - -
breaths/minute, and a diminished level of Ans: A
consciousness would indicate magnesium toxicity.
A family history of gestational hypertension, such as
a mother or sister, is considered a risk factor for the
The nurse is developing a plan of care for a woman client. Having a twin sister or having a sister-in-law
who is pregnant with twins. The nurse includes with gestational hypertension would not increase the
interventions focusing on which of the following client's risk. If the client had a history of preeclampsia
because of the woman's increased risk? in her first pregnancy, then she would be at risk in her
second pregnancy.
A) Oligohydramnios
B) Preeclampsia
C) Post-term labor The nurse is reviewing the laboratory test results of a
D) Chorioamnionitis - -Ans: B pregnant client. Which one of the following findings
would alert the nurse to the development of HELLP
Women with multiple gestations are at high risk for syndrome?
preeclampsia, preterm labor, hydramnios,
hyperemesis gravidarum, anemia, and antepartal A) Hyperglycemia
hemorrhage. There is no association between B) Elevated platelet count
multiple gestations and the development of C) Leukocytosis
chorioamnionitis. D) Elevated liver enzymes - -Ans: D

HELLP is an acronym for hemolysis, elevated liver
A woman hospitalized with severe preeclampsia is enzymes, and low platelets. Hyperglycemia or
being treated with hydralazine to control blood leukocytosis is not a part of this syndrome.
pressure. Which of the following would the lead the
nurse to suspect that the client is having an adverse
effect associated with this drug? Which of the following would the nurse have readily
available for a client who is receiving magnesium
A) Gastrointestinal bleeding sulfate to treat severe preeclampsia?
B) Blurred vision
C) Tachycardia A) Calcium gluconate
D) Sweating - -Ans: C B) Potassium chloride
C) Ferrous sulfate
Hydralazine reduces blood pressure but is D) Calcium carbonate - -Ans: A
associated with adverse effects such as palpitation,
tachycardia, headache, anorexia, nausea, vomiting, The antidote for magnesium sulfate is calcium
1/3

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