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
Abdominal pain with scant red vaginal bleeding is not a finding that supports placenta previa. This finding may indicate placental abruption, which is the premature separation of the placenta from the uterine wall. Placental abruption is a medical emergency that can cause severe bleeding, pain, and fetal distress.
Choice B rationale
Intermittent abdominal pain following passage of bloody mucus is not a finding that supports placenta previa. This finding may indicate the onset of labor, which is characterized by contractions and the expulsion of the mucus plug that seals the cervix. Labor can be normal or preterm, depending on the gestational age of the fetus.
Choice C rationale
Increasing abdominal pain with a nonrelaxed uterus is not a finding that supports placenta previa. This finding may indicate uterine rupture, which is the tearing of the uterine wall. Uterine rupture is a rare but life-threatening complication that can cause severe bleeding, shock, and fetal death.
Choice D rationale
Painless red vaginal bleeding is a finding that supports placenta previa. Placenta previa is a condition where the placenta covers part or all of the cervix, which is the opening of the uterus. Placenta previa can cause bleeding when the cervix dilates or contracts, or when the placenta detaches from the uterine wall. The bleeding is usually painless because the placenta has no nerve endings.
Correct Answer is C
Explanation
Choice A rationale
Changing the client's position is not the first action the nurse should take. Changing the client's position may improve the blood flow and oxygen delivery to the placenta and the fetus, but it is not the most urgent intervention. The nurse should change the client's position after administering oxygen and notifying the provider.
Choice B rationale
Applying a fetal scalp electrode is not the first action the nurse should take. Applying a fetal scalp electrode may provide a more accurate and continuous monitoring of the FHR, but it is not the most urgent intervention. The nurse should apply a fetal scalp electrode only if the external monitor is not reliable or if the provider orders it.
Choice C rationale
Administering oxygen at 10 L/min via a nonrebreather mask is the first action the nurse should take. Administering oxygen is the most urgent intervention to increase the oxygen saturation and prevent fetal hypoxia. Late decelerations are a sign of uteroplacental insufficiency, which means that the placenta is not delivering enough oxygen to the fetus. The nurse should administer oxygen and notify the provider immediately.
Choice D rationale
Increasing the rate of the IV infusion is not the first action the nurse should take. Increasing the rate of the IV infusion may improve the blood volume and perfusion to the placenta and the fetus, but it is not the most urgent intervention. The nurse should increase the rate of the IV infusion after administering oxygen and notifying the provider.
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
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.