A patient receiving hydralazine IV for severe preeclampsia develops tachycardia and headache. What is the appropriate nursing action?
Stop the medication and notify the provider
Continue infusion and reassess in 30 minutes
Administer another antihypertensive
Document and continue observation
The Correct Answer is A
Hydralazine adverse effects are common during intravenous administration, especially in obstetric patients with severe preeclampsia. Hydralazine is a direct arteriolar vasodilator used to lower diastolic blood pressure rapidly. It acts by relaxing vascular smooth muscle, leading to decreased systemic vascular resistance. However, this vasodilation can trigger reflex sympathetic activation, resulting in tachycardia, headache, and palpitations. These symptoms may indicate excessive hypotension or cerebral vasodilation, both of which are dangerous in preeclampsia. Hydralazine is contraindicated in patients with tachyarrhythmias, angina, or increased intracranial pressure.
Rationale for correct answer
1. Stopping the medication and notifying the provider is appropriate because tachycardia and headache suggest adverse effects from hydralazine-induced vasodilation. These symptoms may reflect excessive hypotension or cerebral hyperperfusion, both of which can worsen maternal and fetal outcomes. Immediate cessation prevents further hemodynamic instability.
Rationale for incorrect answers
2. Continuing the infusion and reassessing in 30 minutes is unsafe. Tachycardia and headache are not mild side effects but signs of hemodynamic stress. Delaying intervention risks progression to hypotension, fetal compromise, or stroke. Reassessment without action is inappropriate.
3. Administering another antihypertensive without evaluating the cause of symptoms may worsen the situation. Combining agents can lead to synergistic hypotension and further cardiac strain. The priority is to stop the offending drug and reassess before initiating new therapy.
4. Documenting and continuing observation ignores the clinical significance of the symptoms. Headache in preeclampsia may signal cerebral edema or vasospasm, and tachycardia may indicate compensatory response to hypotension. Passive observation delays necessary intervention.
Take home points
- Hydralazine causes reflex tachycardia and headache due to arteriolar vasodilation.
- These symptoms may indicate excessive hypotension or cerebral hyperperfusion.
- Immediate cessation and provider notification are required for adverse reactions.
- Monitoring for neurological and cardiovascular signs is critical in preeclampsia.
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Correct Answer is B
Explanation
Magnesium sulfate toxicity is a life-threatening complication that can occur during treatment for severe preeclampsia or eclampsia. Magnesium sulfate depresses neuromuscular transmission and central nervous system activity, and toxicity manifests with hyporeflexia, respiratory depression, and cardiac arrest. The antidote is calcium gluconate, which antagonizes magnesium’s effects at the neuromuscular junction and restores muscle contractility. Calcium gluconate is administered IV, typically 1 g over 3 minutes. Magnesium is renally excreted, so toxicity risk increases with renal impairment. Therapeutic serum magnesium levels range from 4.8 to 8.4 mg/dL.
Rationale for correct answer
2. Calcium gluconate is the antidote for magnesium sulfate toxicity. It restores neuromuscular function by competing with magnesium at calcium channels and reversing respiratory depression. It is administered IV and acts rapidly to prevent progression to cardiac arrest.
Rationale for incorrect answers
1. Sodium bicarbonate is used to correct metabolic acidosis, not magnesium toxicity. It does not antagonize magnesium at the neuromuscular junction and has no role in reversing respiratory depression caused by magnesium.
3. Potassium chloride is used to treat hypokalemia, not magnesium toxicity. It can worsen cardiac conduction abnormalities if given during magnesium-induced bradycardia or heart block. It does not reverse magnesium’s neuromuscular effects.
4. Furosemide is a loop diuretic used to promote renal excretion of magnesium, but it is not an antidote. It acts slowly and is not suitable for acute reversal of toxicity. It may be used adjunctively after stabilization.
Take home points
- Calcium gluconate is the antidote for magnesium sulfate toxicity.
- Magnesium toxicity presents with hyporeflexia, respiratory depression, and cardiac arrest.
- Renal impairment increases the risk of magnesium accumulation.
Furosemide may aid magnesium excretion but is not an emergency antidote.
Correct Answer is C
Explanation
Severe preeclampsia is a hypertensive disorder of pregnancy characterized by blood pressure ≥160/110 mmHg, proteinuria ≥0.3 g/24h, and signs of end-organ dysfunction. It poses a high risk for eclampsia, defined by new-onset seizures. The cornerstone of seizure prophylaxis is magnesium sulfate, which acts as a central nervous system depressant by blocking neuromuscular transmission and reducing cerebral vasospasm. It is not an antihypertensive but is essential for preventing convulsions. Therapeutic serum magnesium levels range from 4.8 to 8.4 mg/dL. Toxicity presents with hyporeflexia, respiratory depression, and cardiac arrest, especially in renal impairment.
Rationale for correct answer
3. Magnesium sulfate is the drug of choice for seizure prophylaxis in severe preeclampsia. It reduces the risk of progression to eclampsia by stabilizing neuronal membranes and decreasing excitability. It does not lower blood pressure but is critical in preventing maternal morbidity from seizures.
Rationale for incorrect answers
1. Labetalol is a beta-blocker used to manage acute hypertension in preeclampsia. It reduces systemic vascular resistance but has no anticonvulsant properties. It is not used for seizure prevention and does not affect neuronal excitability.
2. Hydralazine is a direct vasodilator used to lower diastolic blood pressure in hypertensive emergencies. It is effective for blood pressure control but lacks central nervous system depressant effects. It does not prevent seizures and is not the standard for eclampsia prophylaxis.
4. Nifedipine is a calcium channel blocker used for blood pressure reduction in pregnancy. It relaxes vascular smooth muscle but does not cross the blood-brain barrier to exert anticonvulsant effects. It is not indicated for seizure prevention in preeclampsia.
Take home points
- Magnesium sulfate is the first-line agent for seizure prophylaxis in severe preeclampsia.
- Antihypertensives like labetalol, hydralazine, and nifedipine manage blood pressure but do not prevent seizures.
- Eclampsia is defined by new-onset seizures in a preeclamptic patient.
- Magnesium toxicity presents with hyporeflexia and respiratory depression.
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