Drug Therapy
Inpatient Management
MISC.
Home Care
Pathophysiology & Risk Factors
100
Q. A nurse is caring for a 16- year old patient who is gravida 1 para 0. The client is admitted to the labor unit showing signs of early labor. She has a blood pressure of 168/102 mm Hg, 3+ protein in her urine, and her face and hands are both very swollen. Which of the following medications should the nurse anticipate the provider will prescribe in this situation?
A. Magnesium Sulfate Rationale: Magnesium sulfate is an anticonvulsant that would be prescribed for a client who is exhibiting signs and symptoms of severe preeclampsia as evidenced by this client’s elevated BP and 3+ proteinuria.
100
Q. What is the roll of Oxytocin?
A. It induces labor by stimulating uterine contractions
100
Q. What is the difference between gestational hypertension and chronic hypertension in a pregnant woman?
A. A woman with gestational hypertension will return to her baseline BP by 6 weeks postpartum. If her GH persists for over 6 weeks then chronic HTN is diagnosed.
100
Q. While at home on activity restrictions- the woman should lie down for at least 1 ½ hours per day in a side lying position for what purpose?
A. In order to maximize placental blood flow.
100
Q. Preeclampsia is the result of what?
A. Generalized vasospasm
200
Q. Magnesium Sulfate reduces vasoconstriction, which results in reduced blood pressure- however its main goal is to do what?
A. Acts as a CNS depressant to relax smooth muscle (and the uterus) to and therefore prevent seizures.
200
Q.Fill in the blank: Most seizures occur during ________ and the ___________ period.
A. Labor, postpartum
200
Q. What are the two specific signs of Preeclampsia?
A. 1) Raised blood pressure (systolic > 140 mm Hg or diastolic > 90 mm Hg) 2) Proteinuria (> 0.3 g)
200
Q. How should the woman weigh herself each morning?
A. On the same scale and in clothing of similar weight.
200
Q. In a normal pregnancy, what is most likely the reason that blood pressure does not rise?
A. Because pregnant women develop resistance to the effects of vasoconstrictors.
300
Q. A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all that apply) a. Respirations less that 12/ min b. Urinary output less than 30/mL/hour c. Hyperreflexic deep-tendon reflexes d. Decreased level of consciousness e. Flushing and sweating
A. a, b, d Rationale: Signs of magnesium toxicity include respirations less than 12/min, decreased level of consciousness, and the absences of deep-tendon reflexes. Flushing and sweating are side effects, but not signs of toxicity.
300
Q. With regard to seizures, what position should a woman be kept in during labor and why?
A. She should be kept in a lateral position in order to promote circulation through the placenta.
300
Q. What is the only “cure” for Gestational hypertension?
A. Delivery. Rationale: When a woman delivers – her BP should return to baseline by 6 weeks postpartum.
300
Q. How should a woman perform a test for protein?
A. She should use a urine dipstick - using the first voided midstream specimen- daily.
300
Q. Name at least 5 different risk factors of pregnancy related hypertension:
A. *First time pregnancy for mother or father of baby *Maternal age over 35 *Anemia *Family/personal history of preeclampsia (Genetics) *African America *Chronic HTN/preexisting vascular disease *Chronic renal disease *Obesity *Diabetes *Multifetal Pregnancy *Pregnancy from assisted reproductive techniques *Men who have fathered other preeclampsia pregnancies *Antiphospholipid Syndrome
400
Q. In the event that a patient is showing signs of Magnesium toxicity, what is the antidote that the nurse should anticipate administering?
A. Calcium Gluconate is the antidote for magnesium sulfate Rationale: There should be a standing order to be administered in the event of a magnesium sulfate toxicity.
400
Q. Fill in the blank: The antihypertensive medication Hydralazine (Apresoline) is commonly used because it is a ___________ that increases both _____ _____ and _____ ______ to the placenta and has a high record of safety.
A. Vasodilator, cardiac output, blood flow
400
Q. Where is pain generally felt when a woman has HELLP syndrome?
A. Right upper quadrant, lower chest or epigastric. Rationale: There may be liver distention from increase of liver enzymes due to hepatic blood flow obstruction.
400
Q. How does a woman record fetal movements?
A. “Kick Count”- For one hour a day the woman should lay down and count the fetal movements (should be at least 3 movements in a 60 minute period)
400
Q. What are some things that a vasospasm (which leads to preeclampsia) can result in? (Name at least 2)
A. Endothelial cell damage and decreased EDRF, as well as impeded blood blow and elevated blood pressure
500
Q. How is Magnesium Sulfate excreted?
A. Solely through the kidneys.
500
Q. Following birth, what two things are important to assess and why are they significant?
A. The mother’s blood loss and signs of shock. Rationale: the hypovolemia that was caused by preeclampsia can be further aggravated by blood loss during the birth.
500
Q. What are some warning signs of probable convulsions (which precede Eclapmsia)?
A. Headache, severe epigastric pain, hyperreflexia, hemocontractions
500
Q. How should the nurse educate the woman and her family regarding use of electronic blood pressure equipment?
A. BP should be checked two to four times per day, in the same arm and with the woman in the same position.
500
Q. Which essential organs have decreased circulation and are directly affected by a vasospasm? (Name at least 2)
A. Kidneys, liver, brain and placenta.
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