A school nurse is preparing a seminar to address the concerns of pregnant adolescents. Which information is most important for the nurse to include in the program?

Choice A rationale: Hydralazine is a direct-acting vasodilator that reduces systemic vascular resistance, lowering blood pressure by relaxing arterial smooth muscle. In postpartum preeclampsia, where diastolic pressures exceed 100 mm Hg and symptoms like headache or visual changes emerge, immediate antihypertensive therapy is essential to prevent complications such as stroke or eclampsia. The typical target is to maintain systolic <160 mm Hg and diastolic <110 mm Hg to reduce cerebral perfusion pressure without compromising uteroplacental circulation.

Choice B rationale: Hyperreflexia, as evidenced by 4+ deep tendon reflexes, may precede seizures in hypertensive disorders of pregnancy. Reflex monitoring every 4 hours helps assess neurological status and screen for worsening cerebral irritability, allowing early magnesium sulfate administration. Reflexes become exaggerated due to central nervous system hyperexcitability from endothelial dysfunction and increased intracellular calcium in preeclampsia. Monitoring helps distinguish therapeutic levels of magnesium and potential toxicity, which manifests as diminished reflexes.

Choice C rationale: Seizure precautions reduce risk of aspiration, physical injury, and hypoxia in clients with postpartum preeclampsia at high risk of eclampsia. Elevated BP, headache, RUQ pain, and visual disturbances indicate severe cerebral involvement. Pathophysiology involves vasospasm, cerebral edema, and hemorrhage risk due to endothelial dysfunction. Protective measures include padded side rails, suction readiness, oxygen availability, and quiet environment. These interventions support patient safety until prophylactic anticonvulsant therapy stabilizes neuronal excitability.

Choice D rationale: Oral fluid encouragement may seem logical in mild dehydration, but this client’s presentation does not include signs of volume depletion—her skin turgor is intact. Encouraging oral fluids amid nausea and potential magnesium therapy (which can suppress gut motility) risks further discomfort. Fluid management in postpartum preeclampsia must be cautious to avoid pulmonary edema due to increased capillary permeability and third-spacing. IV access ensures controlled fluid and medication administration based on evolving clinical status.

Choice E rationale: Serum magnesium sulfate levels are typically not drawn STAT unless there’s concern for toxicity or treatment failure. The more urgent clinical priority is initiating magnesium therapy based on reflex status and symptoms. Magnesium sulfate is given empirically at seizure threshold, not contingent on baseline levels. Its mechanism includes NMDA receptor blockade and calcium antagonism, reducing neuronal excitability. STAT levels may delay treatment and are more relevant in maintenance therapy or overdose scenarios.

Choice F rationale: Frequent BP monitoring every 15 minutes enables prompt detection of hypertensive surges and therapy response. Postpartum preeclampsia can progress rapidly, and tight surveillance helps guide repeat hydralazine dosing and assess seizure risk. Hemodynamic changes are driven by systemic endothelial damage, increased vascular resistance, and fluid shifts. This monitoring aligns with hypertensive crisis protocols, supporting early intervention to avoid cerebral hemorrhage, myocardial strain, or renal damage.

Choice A rationale

Zidovudine is a nucleoside reverse transcriptase inhibitor (NRTI). It works by inhibiting the enzyme reverse transcriptase, which is crucial for the replication of retroviruses like HIV. It does not possess any antifungal properties. Fungal infections, such as candidiasis, are often treated with antifungal agents like fluconazole, not antiretroviral drugs.

Choice B rationale

Chorioamnionitis is an intrauterine infection of the chorion and amnion, typically caused by ascending bacteria. It is treated with broad-spectrum antibiotics to address the bacterial etiology. Zidovudine is an antiviral medication specifically targeting the replication of HIV and is ineffective against bacterial infections.

Choice C rationale

Zidovudine works by inhibiting reverse transcriptase, thereby preventing the viral RNA of HIV from being converted into DNA. This mechanism significantly reduces the viral load in the mother and the risk of transplacental transmission to the fetus. This strategy is a cornerstone of preventing perinatal HIV transmission.

Choice D rationale

While zidovudine is a component of highly active antiretroviral therapy (HAART) for managing HIV infection in adults, its primary purpose in the context of labor and delivery is to prevent vertical transmission to the newborn. The treatment regimen for the mother's own HIV complications is a separate, long-term protocol.