A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain.
Nursing care is based on the knowledge that these signs are an indication of:
Anxiety due to hospitalization.
Effects of magnesium sulfate.
Worsening disease and impending convulsion.
Gastrointestinal upset.
Gastrointestinal upset.
The Correct Answer is C
Choice A reason: Anxiety due to hospitalization is not a likely cause of the signs reported by the patient. Anxiety can cause some symptoms, such as headache, palpitations, or sweating, but it does not cause visual changes or epigastric pain. Anxiety is also not a common complication of pregnancy-induced hypertension, which is a condition characterized by high blood pressure and protein in the urine.
Choice B reason: Effects of magnesium sulfate are not a likely cause of the signs reported by the patient. Magnesium sulfate is a medication used to prevent seizures and lower blood pressure in patients with pregnancy-induced hypertension. It can cause some side effects, such as flushing, nausea, or drowsiness, but it does not cause headache, visual changes, or epigastric pain. In fact, magnesium sulfate can help relieve these symptoms by reducing the cerebral edema and vasospasm caused by pregnancy-induced hypertension.
Choice C reason: Worsening disease and impending convulsion are the most likely cause of the signs reported by the patient. These signs indicate that the patient is developing severe preeclampsia or eclampsia, which are life-threatening complications of pregnancy-induced hypertension. Preeclampsia is characterized by high blood pressure, protein in the urine, and signs of organ damage, such as headache, visual changes, epigastric pain, or decreased urine output. Eclampsia is the occurrence of seizures in a patient with preeclampsia. These conditions can lead to stroke, bleeding, placental abruption, or fetal distress, and require immediate medical attention.
Choice D reason: Gastrointestinal upset is not a likely cause of the signs reported by the patient. Gastrointestinal upset can cause some symptoms, such as nausea, vomiting, or abdominal pain, but it does not cause headache, visual changes, or epigastric pain. Gastrointestinal upset is also not a common complication of pregnancy-induced hypertension, which is a condition that affects the blood vessels and organs, not the digestive system.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Biophysical profile is a test that assesses the fetal well-being by measuring five parameters: fetal breathing movements, fetal movements, fetal tone, amniotic fluid volume, and fetal heart rate. It does not predict chromosomal abnormalities in the fetus.
Choice B reason: Lecithin/sphingomyelin [L/S] ratio is a test that measures the amount of two phospholipids in the amniotic fluid. It is used to evaluate the fetal lung maturity and the risk of respiratory distress syndrome. It does not predict chromosomal abnormalities in the fetus.
Choice C reason: Type and crossmatch of maternal and fetal serum is a test that determines the blood type and Rh factor of the mother and the fetus. It is used to identify the risk of hemolytic disease of the newborn due to Rh incompatibility. It does not predict chromosomal abnormalities in the fetus.
Choice D reason: Multiple-marker screening is a test that measures the levels of four substances in the maternal serum: alpha-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and inhibin A. It is used to estimate the risk of Down syndrome, trisomy 18, and neural tube defects in the fetus.
Correct Answer is D
Explanation
Choice A reason: Quickening is the first perception of fetal movement by the pregnant woman, usually felt between 16 and 20 weeks of gestation. However, quickening can also be confused with gas or peristalsis, which are normal digestive processes that cause sensations in the abdomen.
Choice B reason: Chadwick sign is a bluish discoloration of the cervix, vagina, and vulva due to increased blood flow during pregnancy. It can be observed by the examiner as early as 6 weeks of gestation. However, Chadwick sign can also be caused by pelvic congestion, which is a chronic condition of enlarged and dilated veins in the pelvis².
Choice C reason: Amenorrhea is the absence of menstrual periods, which is one of the most common signs of pregnancy. However, amenorrhea can also be caused by stress, endocrine problems, or other factors that affect the hormonal balance and ovulation.
Choice D reason: Goodell sign is the softening of the cervix due to increased vascularity and edema during pregnancy. It can be palpated by the examiner around 6 to 8 weeks of gestation. Goodell sign is not associated with any other condition besides pregnancy, unlike cervical polyps, which are benign growths of the cervical tissue that can cause bleeding or discharge.
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