A nurse is caring for a client with gestational hypertension who has been prescribed magnesium sulfate to prevent seizures related to preeclampsia.

Which of the following assessments should the nurse prioritize?

Respiratory rate and depth

Urine output and color

Blood pressure and heart rate

Level of consciousness and reflexes

Answer and Explanation

The Correct Answer is D

The correct answer is choice D) Level of consciousness and reflexes. This is because magnesium sulfate can cause toxicity and affect the central nervous system, leading to decreased level of consciousness and loss of reflexes. These are signs that the dose of magnesium sulfate should be reduced or stopped.

The nurse should prioritize assessing these parameters to prevent seizures and avoid magnesium toxicity.

Choice A) Respiratory rate and depth is wrong because magnesium sulfate can also cause respiratory depression, but this is a less common and less sensitive indicator of toxicity than level of consciousness and reflexes.

Choice B) Urine output and color is wrong because magnesium sulfate can also cause renal impairment, but this is not directly related to preventing seizures. However, urine output should be monitored to ensure adequate hydration and renal function.

Choice C) Blood pressure and heart rate is wrong because magnesium sulfate can also cause hypotension and bradycardia, but these are not the primary goals of therapy. Blood pressure and heart rate should be monitored to assess the severity of preeclampsia and the response to antihypertensive medications.

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Correct Answer is B

Explanation

The correct answer is choice B. Monitor fetal heart rate continuously.This is because hydralazine is a vasodilator that lowers blood pressure and may cause tachycardia.Tachycardia can affect the fetal heart rate and oxygenation, so continuous monitoring is essential to detect any signs of fetal distress.

Choice A is wrong because hydralazine does not cause orthostatic hypotension, but rather a reflex increase in heart rate and cardiac output.

Orthostatic hypotension is more likely to occur with other antihypertensive drugs such as alpha-blockers or diuretics.

Choice C is wrong because encouraging oral fluid intake may worsen the fluid retention and edema that are common in preeclampsia.Fluid intake should be restricted to avoid pulmonary edema and cerebral edema.

Choice D is wrong because administering oxygen via nasal cannula is not a priority intervention for a woman with severe preeclampsia who is receiving hydralazine IV.Oxygen therapy may be indicated if the woman develops signs of hypoxia, such as dyspnea, cyanosis, or low oxygen saturation.However, oxygen therapy should be used with caution as it may increase oxidative stress and placental vasoconstriction.

A. Swelling of the face, hands or feet B. Decreased urine output or protein in urine C. Severe headache D. Vision changes such as blurring, flashing lights or spots E. Chest pain or shortness of breath.

Correct Answer is ["B","D","E"]

Explanation

The correct answer is choice B, D and E. These are signs and symptoms of preeclampsia, a serious complication of gestational hypertension that can affect the mother and the baby.Preeclampsia is marked by high blood pressure and protein in urine or other signs of organ damage.

Choice A is wrong because swelling of the face, hands or feet is a common symptom of pregnancy and does not necessarily indicate preeclampsia.However, sudden or severe swelling can be a warning sign and should be checked by a healthcare provider.

Choice C is wrong because severe headache is a symptom of preeclampsia, not gestational hypertension.Gestational hypertension is high blood pressure that develops after 20 weeks of pregnancy and does not have protein in urine or other signs of organ damage.

Some normal ranges for blood pressure during pregnancy are:

• Systolic (top number): less than 140 mm Hg

• Diastolic (bottom number): less than 90 mm Hg

Some normal ranges for protein in urine during pregnancy are:

• Less than 300 mg per 24 hours

• Less than 0.3 g per liter

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A nurse is caring for a client with gestational hypertension who has been prescribed magnesium sulfate to prevent seizures related to preeclampsia. Which of the following assessments should the nurse prioritize?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What is a priority nursing intervention for a woman with severe preeclampsia who is receiving hydralazine IV.

Correct Answer is B

Explanation

Which of the following signs and symptoms may indicate worsening condition or preeclampsia in a client with gestational hypertension?

Correct Answer is ["B","D","E"]

Explanation

(Select all that apply). A nurse is providing discharge teaching to a client with gestational hypertension who delivered a healthy baby two days ago. Which of the following statements by the client would indicate a need for further teaching?

A nurse is preparing to administer an IV loading dose of magnesium sulfate to a client who has preeclampsia with severe features. Which of the following actions should the nurse take?

A nurse is caring for a client with gestational hypertension who has been prescribed magnesium sulfate to prevent seizures related to preeclampsia. Which of the following assessments should the nurse prioritize?

Which of the following findings would indicate that a client with preeclampsia is experiencing HELLP syndrome?

Which of the following factors increases a woman’s risk for developing gestational hypertension.

Which of the following is a sign or symptom of gestational hypertension?

A nurse is reviewing laboratory results for a client who has HELLP syndrome. Which of the following findings should the nurse expect? (Select all that apply.)

A nurse is caring for a client with gestational hypertension who has been prescribed methyldopa (Aldomet) to control blood pressure during pregnancy. Which of the following side effects should the nurse monitor for?

A nurse is caring for a client with gestational hypertension who has been prescribed magnesium sulfate to prevent seizures related to preeclampsia.

Which of the following assessments should the nurse prioritize?