A nurse is assessing the fetal heart rate and uterine activity of a client with severe pre-eclampsia who is receiving magnesium sulfate intravenously.

Which of the following findings should the nurse report to the provider immediately?

Fetal heart rate of 140 beats per minute

Uterine contractions every 10 minutes

Fetal heart rate decelerations

Uterine contractions lasting 60 seconds

Answer and Explanation

The Correct Answer is C

C. Fetal heart rate decelerations.

Fetal heart rate decelerations are temporary drops in the fetal heart rate that can indicate fetal distress or lack of oxygen. There are three types of decelerations: early, late and variable. Early decelerations are benign and caused by compression of the fetus’s head during a uterine contraction. Late decelerations are caused by uteroplacental insufficiency, which is a decrease in blood flow to the placenta. Variable decelerations are the most common type and vary in shape, duration and intensity. They are often caused by cord compression or other factors that affect fetal oxygenation.

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A. Fetal heart rate of 140 beats per minute.

Statement is wrong because this is a normal fetal heart rate. The normal range for fetal heart rate is 120-160 beats per minute.

•

B. Uterine contractions every 10 minutes.

Statement is wrong because this is a normal frequency for uterine contractions during early labor.

The normal range for uterine contractions is 5-10 minutes apart.

•

D. Uterine contractions lasting 60 seconds.

Statement is wrong because this is a normal duration for uterine contractions during active labor.

The normal range for uterine contractions is 45-90 seconds long.

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Correct Answer is A

Explanation

According to Mayo Clinic, loss of reflexes is a sign of magnesium toxicity and requires immediate intervention.

Other signs of magnesium toxicity include:

• Decreased urine output

• Difficulty breathing

• Drowsiness or confusion

• Low blood pressure

• Slow heart rate

• Weakness

Choice B is wrong because headache is not a sign of magnesium toxicity.

It may be a symptom of preeclampsia or other conditions, but it does not indicate an overdose of magnesium sulfate.

Choice C is wrong because nausea is not a sign of magnesium toxicity.

It may be a side effect of magnesium sulfate or a symptom of preeclampsia or other conditions, but it does not indicate an overdose of magnesium sulfate.

Choice D is wrong because blurred vision is not a sign of magnesium toxicity.

It may be a symptom of preeclampsia or other conditions, but it does not indicate an overdose of magnesium sulfate.

A. To prevent cerebral edema B. To reduce uterine contractions C. To increase placental perfusion D. To promote diuresis

Correct Answer is C

Explanation

To increase placental perfusion.

Hydralazine is an antihypertensive drug that dilates the blood vessels and lowers the blood pressure.By doing so, it improves the blood flow to the placenta and reduces the risk of fetal hypoxia and growth restriction.

Choice A is wrong because hydralazine does not prevent cerebral edema.

Cerebral edema is a complication of severe preeclampsia or eclampsia that can cause seizures, headaches, and visual disturbances.Hydralazine may lower the blood pressure and reduce the risk of stroke, but it does not directly affect the brain swelling.

Choice B is wrong because hydralazine does not reduce uterine contractions.

Uterine contractions are stimulated by oxytocin and prostaglandins, which are not affected by hydralazine.Hydralazine may cause reflex tachycardia, which can increase the cardiac output and uterine blood flow, but it does not alter the uterine muscle activity.

Choice D is wrong because hydralazine does not promote diuresis.

Diuresis is the increased production of urine by the kidneys.

Hydralazine may cause fluid retention and edema by activating the renin-angiotensin-aldosterone system, which increases sodium and water reabsorption.Hydralazine may also cause a decrease in renal perfusion and glomerular filtration rate, which can impair the kidney function and urine output.

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A nurse is assessing the fetal heart rate and uterine activity of a client with severe pre-eclampsia who is receiving magnesium sulfate intravenously. Which of the following findings should the nurse report to the provider immediately?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is monitoring a client with severe pre-eclampsia who is receiving magnesium sulfate intravenously. Which of the following signs indicates magnesium toxicity and requires immediate intervention?

Correct Answer is A

Explanation

A nurse is preparing to administer hydralazine to a client with eclampsia who has a blood pressure of 180/120 mmHg. What is the rationale for administering this medication?

Correct Answer is C

Explanation

A nurse is reviewing the laboratory results of a client with HELLP syndrome. Which of the following findings would indicate hemolysis?

(select all that apply) A nurse is planning care for a client with eclampsia who is scheduled for delivery as soon as possible. Which of the following interventions should the nurse include in the plan? (Select all that apply.)

A nurse is assessing a client who has eclampsia and is receiving magnesium sulfate IV. Which of the following findings should alert the nurse to suspect magnesium toxicity?

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A nurse is preparing to administer antihypertensive therapy to a client with severe pre-eclampsia. Which of the following blood pressure readings is the target goal for this client?

A nurse is preparing to administer magnesium sulfate IV to a client who has severe pre-eclampsia. Which of the following actions should the nurse take? (Select all that apply.)

A nurse is reviewing the results of a 24-hour urine collection for a client who is 32 weeks pregnant and has suspected pre-eclampsia. Which of the following findings indicates proteinuria?

A nurse is caring for a client with HELLP syndrome who is receiving magnesium sulfate intravenously. What is the main purpose of this medication?

A nurse is assessing the fetal heart rate and uterine activity of a client with severe pre-eclampsia who is receiving magnesium sulfate intravenously.

Which of the following findings should the nurse report to the provider immediately?