High Risk Pregnancy (Preeclampsia) NCLEX Questions and
Answers Rated A
A client is diagnosed with gestational hypertension associated with adverse effects such as palpitation,
and is receiving magnesium sulfate. Which finding tachycardia, headache, anorexia, nausea, vomiting,
would the nurse interpret as indicating a therapeutic and diarrhea. It does not cause gastrointestinal
level of medication? bleeding, blurred vision, or sweating. Magnesium
sulfate may cause sweating.
A) Urinary output of 20 mL per hour
B) Respiratory rate of 10 breaths/minute
C) Deep tendons reflexes 2+ After reviewing a client's history, which factor would
D) Difficulty in arousing - -Ans: C the nurse identify as placing her at risk for gestational
hypertension?
With magnesium sulfate, deep tendon reflexes of 2+
would be considered normal and therefore a A) Mother had gestational hypertension during
therapeutic level of the drug. Urinary output of less pregnancy.
than 30 mL, a respiratory rate of less than 12 B) Client has a twin sister.
breaths/minute, and a diminished level of C) Sister-in-law had gestational hypertension.
consciousness would indicate magnesium toxicity. D) This is the client's second pregnancy. - -
Ans: A
The nurse is developing a plan of care for a woman A family history of gestational hypertension, such as
who is pregnant with twins. The nurse includes a mother or sister, is considered a risk factor for the
interventions focusing on which of the following client. Having a twin sister or having a sister-in-law
because of the woman's increased risk? with gestational hypertension would not increase the
client's risk. If the client had a history of preeclampsia
A) Oligohydramnios in her first pregnancy, then she would be at risk in her
B) Preeclampsia second pregnancy.
C) Post-term labor
D) Chorioamnionitis - -Ans: B
The nurse is reviewing the laboratory test results of a
Women with multiple gestations are at high risk for pregnant client. Which one of the following findings
preeclampsia, preterm labor, hydramnios, would alert the nurse to the development of HELLP
hyperemesis gravidarum, anemia, and antepartal syndrome?
hemorrhage. There is no association between
multiple gestations and the development of A) Hyperglycemia
chorioamnionitis. B) Elevated platelet count
C) Leukocytosis
D) Elevated liver enzymes - -Ans: D
A woman hospitalized with severe preeclampsia is
being treated with hydralazine to control blood HELLP is an acronym for hemolysis, elevated liver
pressure. Which of the following would the lead the enzymes, and low platelets. Hyperglycemia or
nurse to suspect that the client is having an adverse leukocytosis is not a part of this syndrome.
effect associated with this drug?
A) Gastrointestinal bleeding Which of the following would the nurse have readily
B) Blurred vision available for a client who is receiving magnesium
C) Tachycardia sulfate to treat severe preeclampsia?
D) Sweating - -Ans: C
A) Calcium gluconate
Hydralazine reduces blood pressure but is B) Potassium chloride
C) Ferrous sulfate
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Answers Rated A
A client is diagnosed with gestational hypertension associated with adverse effects such as palpitation,
and is receiving magnesium sulfate. Which finding tachycardia, headache, anorexia, nausea, vomiting,
would the nurse interpret as indicating a therapeutic and diarrhea. It does not cause gastrointestinal
level of medication? bleeding, blurred vision, or sweating. Magnesium
sulfate may cause sweating.
A) Urinary output of 20 mL per hour
B) Respiratory rate of 10 breaths/minute
C) Deep tendons reflexes 2+ After reviewing a client's history, which factor would
D) Difficulty in arousing - -Ans: C the nurse identify as placing her at risk for gestational
hypertension?
With magnesium sulfate, deep tendon reflexes of 2+
would be considered normal and therefore a A) Mother had gestational hypertension during
therapeutic level of the drug. Urinary output of less pregnancy.
than 30 mL, a respiratory rate of less than 12 B) Client has a twin sister.
breaths/minute, and a diminished level of C) Sister-in-law had gestational hypertension.
consciousness would indicate magnesium toxicity. D) This is the client's second pregnancy. - -
Ans: A
The nurse is developing a plan of care for a woman A family history of gestational hypertension, such as
who is pregnant with twins. The nurse includes a mother or sister, is considered a risk factor for the
interventions focusing on which of the following client. Having a twin sister or having a sister-in-law
because of the woman's increased risk? with gestational hypertension would not increase the
client's risk. If the client had a history of preeclampsia
A) Oligohydramnios in her first pregnancy, then she would be at risk in her
B) Preeclampsia second pregnancy.
C) Post-term labor
D) Chorioamnionitis - -Ans: B
The nurse is reviewing the laboratory test results of a
Women with multiple gestations are at high risk for pregnant client. Which one of the following findings
preeclampsia, preterm labor, hydramnios, would alert the nurse to the development of HELLP
hyperemesis gravidarum, anemia, and antepartal syndrome?
hemorrhage. There is no association between
multiple gestations and the development of A) Hyperglycemia
chorioamnionitis. B) Elevated platelet count
C) Leukocytosis
D) Elevated liver enzymes - -Ans: D
A woman hospitalized with severe preeclampsia is
being treated with hydralazine to control blood HELLP is an acronym for hemolysis, elevated liver
pressure. Which of the following would the lead the enzymes, and low platelets. Hyperglycemia or
nurse to suspect that the client is having an adverse leukocytosis is not a part of this syndrome.
effect associated with this drug?
A) Gastrointestinal bleeding Which of the following would the nurse have readily
B) Blurred vision available for a client who is receiving magnesium
C) Tachycardia sulfate to treat severe preeclampsia?
D) Sweating - -Ans: C
A) Calcium gluconate
Hydralazine reduces blood pressure but is B) Potassium chloride
C) Ferrous sulfate
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