The clinic nurse’s patient is 21 weeks pregnant. Her blood pressure is 168/100. Blood pressures in prior visits have all been normal. Her urine sample shows trace protein. What other questions or procedures might you ask/perform to determine if your patient is pre-eclamptic. (Select all that apply)

Do you have any headaches or blurry vision?

I am going to check your reflexes now

Have you been having trouble with urinary incontinence?

Do you have any right upper quadrant pain?

Have you had any nausea or vomiting recently?

Do you feel safe at home?

Answer and Explanation

Correct Answer : A,B,D

A. Do you have any headaches or blurry vision? Headaches and blurry vision are common neurological symptoms of preeclampsia. These occur due to cerebral edema and hypertension-related vascular changes. Persistent headaches or visual disturbances (such as seeing spots or flashing lights) warrant further evaluation.

B. I am going to check your reflexes now. Hyperreflexia (brisk deep tendon reflexes) is a key neurological sign of worsening preeclampsia. Severe hyperreflexia can indicate impending eclampsia and increased seizure risk. Checking for clonus (involuntary rhythmic muscle contractions) is also important.

C. Have you been having trouble with urinary incontinence? Urinary incontinence is not a sign of preeclampsia. However, decreased urine output (oliguria) would be concerning as it may indicate worsening renal impairment, but incontinence itself is unrelated.

D. Do you have any right upper quadrant pain? Right upper quadrant or epigastric pain is a concerning sign of liver involvement in severe preeclampsia or HELLP syndrome. It occurs due to liver swelling and can be a precursor to serious complications such as hepatic rupture.

E. Have you had any nausea or vomiting recently? While nausea and vomiting are common in pregnancy, they are not defining symptoms of preeclampsia unless they are sudden and severe. If present in the third trimester, they may suggest worsening disease, but they are not primary indicators.

F. Do you feel safe at home? Screening for domestic violence is important in pregnancy, but it is not a diagnostic question for preeclampsia. While stress and abuse can impact blood pressure, this question does not help in determining preeclampsia.

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Correct Answer is D

Explanation

A. Enteral nutrition (TPN) to correct nutritional deficits. Total parenteral nutrition (TPN) is only considered in severe cases where oral and IV hydration fail. The initial treatment focuses on correcting dehydration and electrolyte imbalances before considering more invasive nutritional support.

B. Small frequent meals. While small, frequent meals may help manage nausea in mild cases of pregnancy-related nausea and vomiting, they are not sufficient for treating hyperemesis gravidarum, which involves severe, persistent vomiting leading to dehydration and electrolyte imbalances.

C. Corticosteroids to reduce inflammation. Corticosteroids are not the first-line treatment for hyperemesis gravidarum. They may be used in refractory cases where standard treatments fail, but IV fluids and antiemetics are prioritized initially.

D. IV therapy to correct fluid and electrolyte imbalances. The primary concern in hyperemesis gravidarum is severe dehydration and electrolyte disturbances due to excessive vomiting. IV fluids, often with electrolytes and thiamine, are the first step in stabilizing the patient before introducing oral intake.

A. "I don't need to see the doctor for another year when I will come back for follow-up B. I will use contraception for the next year C. I need to be monitored for choriocarcinoma during the next year D. I am so sad that I lost this baby

Correct Answer is A

Explanation

A. "I don't need to see the doctor for another year when I will come back for follow-up." This statement is incorrect because close follow-up is essential after a molar pregnancy to monitor for gestational trophoblastic disease (GTD) or choriocarcinoma. Regular hCG level monitoring is required weekly until levels are undetectable, then monthly for at least 6–12 months. Delaying follow-up for a year could lead to missed complications.

B. "I will use contraception for the next year." This statement is correct. Pregnancy should be avoided for at least one year after a molar pregnancy to ensure accurate monitoring of hCG levels. A rising hCG level could indicate malignant transformation rather than a new pregnancy.

C. "I need to be monitored for choriocarcinoma during the next year." This statement is correct. Choriocarcinoma is a potential complication of molar pregnancy, and early detection through serial hCG monitoring is crucial. Any persistent or rising hCG levels may indicate malignancy requiring chemotherapy.

D. "I am so sad that I lost this baby." This statement is understandable. A molar pregnancy is an emotionally distressing event, and feelings of grief and loss are valid. Emotional support, counseling, or support groups may be beneficial for the patient’s mental well-being.

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Naxlex Comprehensive Predictor Exams

The nurse caring for a woman hospitalized for hyperemesis gravidarum would expect that the initial treatment would involve:

Correct Answer is D

Explanation

A patient is being discharged from the hospital after the evacuation of a molar pregnancy. The nurse recognizes that additional discharge teaching is required when the patient makes which statement?

Correct Answer is A

Explanation

The least common cause of long. difficult, or abnormal labor (dystocia) is:

A woman with a history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the primary health care practitioner?

The nurse is preparing to administer methotrexate to the patient. This drug is most often used for which obstetric complication?

A patient has just spontaneously ruptured her membranes. Which of the following factors makes her especially high risk for having a prolapsed cord? Select all that apply.

A laboring woman with Type 1 diabetes is on an IV insulin drip, and the nurse is monitoring her glucose levels hourly. The woman's partner asks why the glucose needs to remain between 70-110 mg/dL. The nurse's response is based on which of the following information?

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to:

A 26-year old having her first baby is 28 weeks pregnant. She experiences bright red, painless vaginal bleeding, soaking one pad. Upon her arrival at the hospital, after placing her on the FHR Monitor, what would be an expected diagnostic procedure?