A nurse is reinforcing education to the family of a client who had an eclamptic seizure.
Which of the following complications of eclamptic seizure should the nurse reinforce in the teaching? (Select all that apply)
Aspiration pneumonia.
Placental abruption.
Fetal hypoxia.
Renal failure.
Migraines.
Cortical blindness.
Correct Answer : A,B,C,D,F
Choice A rationale
Aspiration pneumonia is a significant risk during and after an eclamptic seizure because the client loses consciousness and their protective airway reflexes are compromised. During the tonic-clonic movements, gastric contents may be regurgitated and inhaled into the lungs. This leads to chemical pneumonitis or bacterial infection, severely compromising maternal oxygenation. Normal oxygen saturation should remain above 95.
Choice B rationale
Placental abruption occurs when the placenta prematurely detaches from the uterine wall, often due to the intense uterine contractions and severe vasoconstriction associated with eclampsia. The sudden increase in maternal blood pressure and the physical stress of a seizure can rupture the small maternal vessels at the decidual-placental interface. This leads to internal hemorrhage, which can be life-threatening. Clinical signs include a rigid, painful abdomen and vaginal bleeding, representing a major obstetric emergency.
Choice C rationale
Fetal hypoxia is a direct consequence of maternal seizures and the associated physiological changes. During a seizure, maternal apnea and intense uterine vasoconstriction occur, which sharply reduces the flow of oxygenated blood through the placenta to the fetus. This results in prolonged fetal heart rate decelerations or bradycardia. Because the fetus has limited oxygen reserves, these repetitive or prolonged episodes of maternal hypoxia during eclampsia can lead to metabolic acidosis, permanent neurological injury, or intrauterine death.
Choice D rationale
Renal failure can occur following an eclamptic seizure due to profound systemic vasospasm and reduced perfusion to the kidneys. Preeclampsia and eclampsia cause glomerular endotheliosis, which decreases the glomerular filtration rate. Normal serum creatinine levels in pregnancy are typically 0.4 to 0.8 mg/dL; levels exceeding 1.1 mg/dL indicate significant renal impairment. The added stress of a seizure and potential hypovolemia can push the kidneys into acute tubular necrosis or acute kidney injury.
Choice E rationale
Migraines are a type of primary headache disorder but are not considered a direct medical complication caused by an eclamptic seizure. While a client with eclampsia will experience a severe, persistent headache due to cerebral edema or hypertension, this is distinct from the pathophysiology of a migraine. Migraines involve neurovascular mechanisms not directly tied to the acute organ damage seen in eclampsia. Therefore, they are not reinforced as a specific complication resulting from the seizure event.
Choice F rationale
Cortical blindness is a rare but documented complication of eclampsia, resulting from edema in the occipital lobes of the brain. This is often part of a spectrum known as Posterior Reversible Encephalopathy Syndrome (PRES). During a seizure, the breakdown of the blood-brain barrier leads to vasogenic edema. While the blindness is usually reversible with the resolution of the edema and control of blood pressure, it represents severe central nervous system involvement and significant morbidity.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
While ischemia can occur in severe cases, the fundamental pathophysiology of gestational hypertension and intrauterine growth restriction is a chronic reduction in perfusion rather than an acute ischemic event. Acute ischemia usually refers to a sudden, total blockage of blood flow, such as in placental abruption. In gestational hypertension, the vascular changes are progressive and lead to chronic insufficiency, which gradually restricts the delivery of nutrients to the developing fetus.
Choice B rationale
Trophoblast necrosis is actually increased in conditions like gestational hypertension and intrauterine growth restriction. Normal pregnancy requires healthy trophoblast invasion to remodel the spiral arteries into low-resistance vessels. In hypertensive disorders, this remodeling is incomplete, leading to high-resistance vessels that are prone to oxidative stress and cell death. Therefore, a decrease in necrosis is incorrect; the pathology involves increased cellular damage and dysfunction within the placental tissues.
Choice C rationale
Reduced placental hypoxia is the opposite of what occurs in intrauterine growth restriction and gestational hypertension. The restricted blood flow and high vascular resistance lead to a state of chronic placental hypoxia. This oxygen deprivation triggers the release of anti-angiogenic factors into the maternal circulation, which further exacerbates maternal hypertension. Hypoxia is a central feature of the placental environment in these diagnoses, driving the poor fetal growth observed clinically.
Choice D rationale
The primary pathophysiological mechanism in gestational hypertension and intrauterine growth restriction is a decrease in placental blood flow. This occurs because the maternal spiral arteries do not dilate properly, maintaining a high-resistance state. Consequently, the placenta receives less oxygenated, nutrient-rich blood from the mother. This chronic under-perfusion prevents the fetus from reaching its full growth potential, directly resulting in intrauterine growth restriction as measured by ultrasound and fundal height.
Correct Answer is ["A","C","D"]
Explanation
Choice A rationale
Weight loss is a primary clinical indicator of hyperemesis gravidarum, typically defined as a loss of more than 5.
Choice B rationale
Abdominal cramping is not a typical manifestation of hyperemesis gravidarum and usually suggests other obstetric complications like spontaneous abortion, ectopic pregnancy, or gastrointestinal distress. Hyperemesis is characterized by upper gastrointestinal symptoms related to intractable nausea and vomiting. While the act of vomiting can strain abdominal muscles, rhythmic or sharp cramping is a localized uterine or bowel symptom that warrants a separate differential diagnosis to ensure the pregnancy remains viable and the uterus is stable.
Choice C rationale
Severe, protracted vomiting is the defining characteristic of hyperemesis gravidarum, likely linked to rapidly rising levels of human chorionic gonadotropin and estrogen. This goes beyond typical morning sickness, as the vomiting is frequent and prevents the retention of liquids or solids. This persistent gastric emptying leads to dehydration and the presence of ketones in the urine, as the body turns to lipid metabolism in the absence of glucose, which further irritates the chemical triggers for nausea.
Choice D rationale
Electrolyte imbalances occur as a direct result of losing gastric hydrochloric acid, potassium, and sodium during repeated bouts of emesis. The client may develop hypokalemia, where potassium is < 3.5 mEq/L, and metabolic alkalosis due to the loss of hydrogen ions. These imbalances interfere with normal cellular function, cardiac conduction, and nerve transmission. Maintaining homeostasis becomes difficult without intravenous fluid and electrolyte replacement to restore the normal plasma concentrations required for maternal and fetal health during gestation.
Choice E rationale
Vaginal blood spotting is not associated with hyperemesis gravidarum and is instead a warning sign of potential miscarriage, cervical irritation, or implantation issues. Hyperemesis is strictly a metabolic and gastrointestinal disorder. The presence of blood in the vaginal canal requires a pelvic exam or ultrasound to assess the cervix and placenta. Including this as an expected finding for hyperemesis would be a clinical error, as it indicates a completely different physiological process involving the reproductive tract.
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