Which of the following interventions should be included in the plan of care for a client with severe preeclampsia? (Select all that apply.)

Administer antihypertensive medications as prescribed

Monitor urine output hourly

Encourage bed rest in a quiet environment

Administer magnesium sulfate as prescribed

Monitor fetal heart rate continuously

Answer and Explanation

Correct Answer : A,B,C,D

The correct answer is choices A, B, C and D. These are all interventions that can help lower blood pressure, prevent seizures, and monitor the health of the mother and the baby in severe preeclampsia.

Choice E is wrong because continuous fetal heart rate monitoring is not necessary for severe preeclampsia unless there are signs of fetal distress or labor. Intermittent auscultation or nonstress test can be used instead to assess fetal well-being.

Normal ranges for blood pressure are below 140/90 mmHg, for urine output are 30 mL/hour or more, for platelet count are 150,000 to 450,000 per microliter, and for liver enzymes are 7 to 56 units per liter for AST and 0 to 35 units per liter for ALT. Magnesium sulfate levels should be maintained between 4 to 7 mg/dL to prevent toxicity. Fetal heart rate should be between 110 to 160 beats per minute.

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Correct Answer is B

Explanation

The correct answer is choice B. Monitor fetal heart rate continuously.This is because hydralazine is a vasodilator that lowers blood pressure and may cause tachycardia.Tachycardia can affect the fetal heart rate and oxygenation, so continuous monitoring is essential to detect any signs of fetal distress.

Choice A is wrong because hydralazine does not cause orthostatic hypotension, but rather a reflex increase in heart rate and cardiac output.

Orthostatic hypotension is more likely to occur with other antihypertensive drugs such as alpha-blockers or diuretics.

Choice C is wrong because encouraging oral fluid intake may worsen the fluid retention and edema that are common in preeclampsia.Fluid intake should be restricted to avoid pulmonary edema and cerebral edema.

Choice D is wrong because administering oxygen via nasal cannula is not a priority intervention for a woman with severe preeclampsia who is receiving hydralazine IV.Oxygen therapy may be indicated if the woman develops signs of hypoxia, such as dyspnea, cyanosis, or low oxygen saturation.However, oxygen therapy should be used with caution as it may increase oxidative stress and placental vasoconstriction.

A. Cerebral hemorrhage B. Pulmonary edema C. Liver rupture D. Disseminated intravascular coagulation

Correct Answer is A

Explanation

The correct answer is choice A. Cerebral hemorrhage.Eclampsia is a severe complication of preeclampsia that causes seizures and can lead to stroke or death.Cerebral hemorrhage is bleeding in the brain that can result from high blood pressure and swelling in the brain caused by eclampsia.It is one of the most common causes of death in women with eclampsia.

Choice B. Pulmonary edema is wrong because it is not the most common cause of death in women with eclampsia.

Pulmonary edema is fluid accumulation in the lungs that can impair breathing and oxygen exchange.It can occur as a complication of eclampsia, but it is less frequent than cerebral hemorrhage.

Choice C. Liver rupture is wrong because it is not the most common cause of death in women with eclampsia.

Liver rupture is a rare but serious complication of eclampsia that involves bleeding from the liver due to increased pressure and damage to the liver tissue.It can cause severe abdominal pain, shock and death.

Choice D. Disseminated intravascular coagulation (DIC) is wrong because it is not the most common cause of death in women with eclampsia.

DIC is a condition where the blood clotting system becomes overactive and forms clots throughout the body, leading to bleeding and organ failure.It can occur as a complication of eclampsia, but it is less common than cerebral hemorrhage.

Normal ranges for blood pressure are below 140/90 mmHg and for proteinuria are below 300 mg/24 hours or below 30 mg/dL in a urine sample.

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Which of the following interventions should be included in the plan of care for a client with severe preeclampsia? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

What is a priority nursing intervention for a woman with severe preeclampsia who is receiving hydralazine IV.

Correct Answer is B

Explanation

What is the most common cause of death in women with eclampsia.

Correct Answer is A

Explanation

A nurse is reviewing laboratory results for a client who has HELLP syndrome. Which of the following findings should the nurse expect? (Select all that apply.)

Which of the following factors increases a woman’s risk for developing gestational hypertension.

A nurse is caring for a client with gestational hypertension who has been prescribed magnesium sulfate to prevent seizures related to preeclampsia. Which of the following assessments should the nurse prioritize?

A nurse is preparing to administer an IV loading dose of magnesium sulfate to a client who has preeclampsia with severe features. Which of the following actions should the nurse take?

A client is diagnosed with preeclampsia and is receiving magnesium sulfate IV for seizure prophylaxis. The nurse should monitor which of the following laboratory values?

Which of the following signs and symptoms may indicate worsening condition or preeclampsia in a client with gestational hypertension?

Which of the following is a sign or symptom of gestational hypertension?

A nurse is reviewing the laboratory results of a client with gestational hypertension who has been diagnosed with HELLP syndrome. Which of the following findings would the nurse expect to see?