A nurse is assessing a pregnant client at 34 weeks gestation, diagnosed with severe preeclampsia.
Which finding requires immediate intervention and indicates a progression to eclampsia?
Weight gain.
Proteinuria.
A generalized seizure not attributed to other causes.
Hyperemesis gravidarum.
Hyperemesis gravidarum.
The Correct Answer is C
Choice A rationale
Weight gain is a common clinical feature of preeclampsia due to systemic endothelial dysfunction leading to fluid shift into the interstitial space. While rapid weight gain of more than 2 pounds per week may indicate worsening edema and fluid retention, it is a non-specific finding that does not define the transition to eclampsia. It requires monitoring but does not represent the acute neurological emergency characterized by convulsive activity that defines the eclamptic state in a pregnant patient.
Choice B rationale
Proteinuria, defined as 300 mg or more of protein in a 24-hour urine collection or a protein to creatinine ratio of 0.3 or more, is a hallmark of preeclampsia. It results from glomerular capillary endotheliosis, which increases the permeability of the basement membrane. While its presence confirms the diagnosis of preeclampsia and reflects renal involvement, it is not the diagnostic criterion for eclampsia. Normal urine protein is typically less than 150 mg per 24 hours.
Choice C rationale
The occurrence of a generalized tonic-clonic seizure in a woman with preeclampsia that cannot be attributed to other causes is the definitive diagnostic event for eclampsia. This represents severe central nervous system irritability and cerebral edema. Immediate intervention is required to maintain the airway, prevent maternal injury, and manage hypertension. This progression indicates a critical escalation of the disease process that significantly increases the risk of maternal and fetal morbidity and mortality including cerebral hemorrhage.
Choice D rationale
Hyperemesis gravidarum is a condition characterized by severe nausea and vomiting during pregnancy that leads to dehydration, weight loss, and electrolyte imbalances. While severe preeclampsia can sometimes involve epigastric or right upper quadrant pain due to liver capsule stretching, hyperemesis is a distinct entity usually occurring earlier in pregnancy. It is not a sign of progression to eclampsia. Management involves fluid resuscitation and antiemetics rather than the anticonvulsant therapy required for the eclamptic transition.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice C rationale
Increasing the volume of speech often results in distortion of sound and can alter the natural cadence and inflection of the voice, making it harder for a child with hearing loss to interpret. Shouting also changes the visual appearance of the mouth, which interferes with lip-reading. Most hearing-impaired individuals benefit from clarity and directness rather than increased decibels. Effective communication relies on a consistent, moderate tone that does not visually or auditorily mask speech patterns.
Choice A rationale
Maintaining direct eye contact and facing the child is a fundamental technique for communicating with the hearing impaired. This position allows the child to utilize non-verbal cues, facial expressions, and lip-reading to supplement any residual hearing they may have. It ensures that the sound waves are directed toward the listener without being muffled by the speaker turning away. This alignment is essential for maximizing the child's ability to process linguistic information through multiple sensory channels.
Choice B rationale
Speaking clearly and at a slightly moderated pace allows the child more time to process each phoneme and word. Rapid speech can cause sounds to blend together, making it difficult for the child to distinguish between similar-sounding syllables. By slowing down slightly without over-exaggerating, the nurse provides a clearer auditory and visual template for the child to follow. This technique supports cognitive processing and reduces the frustration associated with missing parts of a conversation.
Choice D rationale
Background noise creates a poor signal-to-noise ratio, which is particularly challenging for children with hearing loss or those using hearing aids. Hearing aids often amplify all sounds equally, meaning that a humming air conditioner or a television can drown out human speech. Minimizing environmental noise ensures that the nurse's voice is the primary auditory input. This allows the child to focus their limited auditory resources on the intended message without competing with irrelevant environmental stimuli.
Choice E rationale
Ensuring the child is attentive before speaking prevents the loss of the initial parts of the message. Children with hearing loss cannot rely on peripheral hearing to "catch" the start of a sentence if they are distracted. By securing their attention first, the nurse ensures the child is ready to use all available visual and auditory tools. This practice establishes a focused communicative environment where the child is mentally prepared to receive and interpret the incoming information.
Correct Answer is B
Explanation
Choice A rationale
Contractions that diminish or disappear with ambulation or a change in position are a hallmark of Braxton Hicks contractions, which are false labor. True preterm labor contractions continue and typically intensify regardless of the client's activity level. If walking causes the sensations to stop, it indicates that the uterus is simply irritable rather than undergoing the coordinated, rhythmic contractions required to cause cervical effacement and dilation, which defines the start of actual physiological labor.
Choice B rationale
True labor contractions, including those in preterm labor, often begin in the lower back and radiate toward the front of the abdomen. This pattern reflects the neurological pathways involved in uterine contractions and the engagement of the fetus in the pelvis. Intermittent contractions that follow this specific radiation pattern and increase in frequency are highly suspicious for preterm labor. Braxton Hicks are generally felt only in the front of the abdomen or the groin area.
Choice C rationale
Irregular contractions that vary in intensity and lack a predictable rhythm are characteristic of Braxton Hicks. These are often described as a tightening or squeezing sensation that does not become stronger or closer together over time. True labor involves a progressive increase in the strength, duration, and frequency of the contractions. When the intensity remains variable and does not follow a crescendo pattern, it is less likely to be causing the cervical changes of labor.
Choice D rationale
The timing of contractions in the evening is not a definitive diagnostic feature of preterm labor. Braxton Hicks contractions often occur more frequently at the end of a long day when the client is tired or dehydrated. While preterm labor can occur at any time, the mere presence of evening contractions without other signs like back pain or cervical change is common in late pregnancy. The diagnostic focus is on the quality and regularity rather than the clock. .
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