Which blood pressure (BP) finding during the second trimester indicates a risk for pregnancy-induced hypertension?
Baseline BP 140/85, current BP 129/80
Baseline BP 110/70, current BP 145/85
Baseline BP 120/80, current BP 126/85
Baseline BP 110/60, current BP 120/63
The Correct Answer is B
Choice A rationale
This is incorrect because a decrease in BP from the baseline is not a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 140/85 mm Hg indicates pre-existing hypertension, which may or may not worsen during pregnancy. A current BP of 129/80 mm Hg indicates an improvement in the BP control, but not a risk for pregnancy-induced hypertension.
Choice B rationale
This is correct because an increase in BP from the baseline by 30 mm Hg systolic or 15 mm Hg diastolic is a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 110/70 mm Hg indicates a normal BP before pregnancy. A current BP of 145/85 mm Hg indicates a significant elevation in the BP, which could lead to complications such as preeclampsia, eclampsia, or placental abruption.
Choice C rationale
This is incorrect because a slight increase in BP from the baseline is not a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 120/80 mm Hg indicates a normal BP before pregnancy. A current BP of 126/85 mm Hg indicates a minor elevation in the BP, which is within the normal range and does not pose a risk for pregnancy-induced hypertension.
Choice D rationale
This is incorrect because a slight increase in BP from the baseline is not a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 110/60 mm Hg indicates a normal BP before pregnancy. A current BP of 120/63 mm Hg indicates a minor elevation in the systolic BP, but a decrease in the diastolic BP, which is within the normal range and does not pose a risk for pregnancy-induced hypertension.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Examination to determine cervical status is not an appropriate nursing action for a client who has suspected placenta previa. This may cause trauma to the placenta and increase the bleeding. The nurse should avoid any vaginal examinations or interventions unless absolutely necessary.
Choice B rationale
Magnesium sulfate infusion is not an appropriate nursing action for a client who has suspected placenta previa. This medication is used to prevent or treat seizures in clients who have preeclampsia or eclampsia, not placenta previa. It may also cause adverse effects such as respiratory depression, hypotension, and decreased fetal heart rate.
Choice C rationale
Initiation of pushing is not an appropriate nursing action for a client who has suspected placenta previa. This may worsen the bleeding and compromise the fetal oxygenation. The nurse should instruct the client to avoid any bearing down or straining.
Choice D rationale
Preparation for cesarean birth is an appropriate nursing action for a client who has suspected placenta previa. This is the preferred mode of delivery for clients who have placenta previa, especially if the bleeding is severe or the fetal distress is present. The nurse should monitor the client's vital signs, fetal heart rate, and blood loss, and notify the provider immediately.
Correct Answer is C
Explanation
Choice A rationale
Fetal head compression is not the cause of late decelerations. Fetal head compression occurs when the fetal head is pressed against the maternal pelvis or cervix during labor. This can cause early decelerations, which are symmetrical decreases in the fetal heart rate that coincide with the uterine contractions.
Choice B rationale
Umbilical cord compression is not the cause of late decelerations. Umbilical cord compression occurs when the umbilical cord is squeezed between the fetal body and the maternal pelvis or uterine wall during labor. This can cause variable decelerations, which are abrupt and irregular decreases in the fetal heart rate that vary in timing and duration.
Choice C rationale
Uteroplacental insufficiency is the cause of late decelerations. Uteroplacental insufficiency occurs when the blood flow and oxygen delivery to the placenta are reduced during labor. This can cause late decelerations, which are symmetrical decreases in the fetal heart rate that begin after the peak of the uterine contractions and return to baseline after the contractions end.
Choice D rationale
Maternal bradycardia is not the cause of late decelerations. Maternal bradycardia is a slow maternal heart rate that can be caused by various factors such as medication, hypotension, or vagal stimulation. Maternal bradycardia can affect the fetal heart rate, but it does not cause a specific pattern of decelerations.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today