A nurse is teaching a pregnant client about the risk factors for pre-eclampsia.
Which of the following should the nurse include? (Select all that apply).
Age over 35 years
First pregnancy
Obesity
Diabetes mellitus
Multiple gestation
Correct Answer : B,C,D,E
The correct answer is choices B, C, D, and E. These are all risk factors for pre-eclampsia according to various sources.
Choice A is wrong because age over 35 years is not a risk factor for pre-eclampsia by itself, although it may be associated with other conditions that increase the risk, such as chronic hypertension or diabetes.
Pre-eclampsia is a complication of pregnancy that involves high blood pressure, protein in the urine, and organ damage. It can affect both the mother and the fetus and can lead to serious complications such as eclampsia (seizures), placental abruption, and stillbirth. It is more common in first pregnancies, especially with a new partner, because of the immune response to the foreign fetal antigens. Obesity, diabetes mellitus, and multiple gestation are also risk factors because they increase the metabolic and vascular demands on the placenta and the mother.
Normal ranges for blood pressure and proteinuria in pregnancy are:
• Blood pressure: less than 140/90 mmHg
• Proteinuria: less than 300 mg/24 hours or less than 30 mg/dL on a random urine sample
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Turn the client to the side.This is because turning the client to the side will prevent aspiration of secretions or vomitus and maintain a patent airway during a seizure.
This is the most important and immediate action to take for a client with eclampsia who is having a tonic-clonic seizure.
Choice A is wrong because administering oxygen via face mask is not the first priority and may not be feasible during a seizure.Oxygen therapy may be indicated after the seizure to improve oxygenation and fetal well-being.
Choice C is wrong because inserting an oral airway is contraindicated during a seizure as it may cause injury to the oral mucosa or trigger a gag reflex.An oral airway may be used after the seizure if the client is unconscious and has a compromised airway.
Choice D is wrong because giving a loading dose of magnesium sulfate is not the first action to take, although it is an important intervention to prevent further seizures and lower blood pressure in eclampsia.Magnesium sulfate should be administered intravenously after securing the airway and ensuring adequate ventilation.
Correct Answer is A
Explanation
Respiratory rate of 10 breaths/min.
This is a sign ofmagnesium toxicity, which can occur when a client receives magnesium sulfate infusion for severe pre-eclampsia.Magnesium toxicity can causemuscle weakness,difficulty breathing,irregular heartbeats, andcardiac arrest.
Choice B is wrong because deep tendon reflexes of 2+ are normal and do not indicate magnesium toxicity.
Choice C is wrong because urine output of 40 mL/hour is adequate and does not indicate magnesium toxicity.
The minimum urine output for an adult is 30 mL/hour.
Choice D is wrong because serum magnesium level of 6 mEq/L is within the normal range of 1.7 to 2.3 mEq/L and does not indicate magnesium toxicity.Magnesium levels above 2.6 mEq/L can indicate hypermagnesemia.
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