Exam 2 (NUR 353) | Questions and Answers (Complete Solutions)
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NUR 353
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NUR 353
Exam 2 (NUR 353) | Questions and Answers (Complete Solutions) A nurse is assessing a patient with preeclampsia who delivered 12 hours ago. Which of the following assessments would indicate that the condition has not yet resolved? a. blood pressure reading at prenatal baseline b. adequate urinary ...
A nurse is assessing a patient with preeclampsia who delivered 12 hours ago.
Which of the following assessments would indicate that the condition has not yet
resolved?
a. blood pressure reading at prenatal baseline
b. adequate urinary output and no proteinuria
c. presence of 1-2+ deep tendon reflexes
d. patient complaints of blurred vision and headache
A nurse is completing the admission assessment of a client who is at 38 weeks
gestation and has severe preeclampsia.
Which one of the following findings is consistent with the diagnosis of severe
preeclampsia?
a. Polyuria
b. Absence of clonus
c. Epigastric pain
d. Tachycardia
Why is magnesium sulfate is given to women with preeclampsia and eclampsia?
a. To improve patellar reflexes and increase respiratory efficiency
b. To prevent and treat convulsions
c. To decrease blood pressure readings
d. To prevent a boggy uterus and lessen lochial flow
A nurse in a prenatal clinic is reviewing results from recent one-hour oral glucose
tolerance tests.
Which one of the 4 pregnant clients needs to be scheduled for a follow-up, diagnostic
three-hour glucose tolerance test?
a. One hour GTT result: 115 mg/dl
b. One hour GTT result: 95 mg/dl
c. One hour GTT result: 125 mg/dl
d. One hour GTT result: 160 mg/dl
A nurse is caring for a client at 30 weeks gestation who has just been diagnosed with
gestational diabetes. The client has a lot of questions about the risks to her baby with
GDM. What is the best explanation by the nurse for why her fetus is at risk for
macrosomia and hypoglycemia at delivery?
,a. To prevent macrosomia, you should only gain 11-20 lbs. total during this pregnancy.
b. When your blood sugar levels are too high, the insulin that you make can cross the
placenta and affect your baby's metabolism.
c. Extra sugar (glucose) can cross the placenta to your baby. This may cause your baby
to gain extra weight and to have sudden low blood glucose after birth.
d. Your baby may be born with diabetes.
What are three classic clinical manifestations of preeclampsia?
1. Proteinuria
2. Epigastric pain
3. Headaches
In a normal pregnancy, spiral arteries widen to improve perfusion to the placenta. In a
preeclamptic pregnancy, the spiral arteries do widen, but not nearly as much which
decreases blood flow to the placenta. Your brain perceives hypo perfusion, and your
brain thinks that you are bleeding out. Your brain is going to release vasoconstrictor
hormones and try to redirect that blood to vital organs, such as the heart, brain, lungs,
etc. Your brain doesn't think of the baby as a vital organ. This vasoconstriction leads to
an increase in blood pressure. Over time, this increase in BP causes wear and tear in
your blood vessels, leading to little holes in the vessels. Your brain stimulates a
lipoprotein to be released to try to repair the vessels, but they are not able to. The
lipoprotein leaks out from the vessels and into the intravascular space. The proteins
attract water which causes edema. Liver necrosis can occur long term due to the
initiation of the clotting cascade by the brain, causing hypoxia, then ischemia, then
necrosis.
Pathophysiology of preeclampsia.
Hypertensive disorder of pregnancy whereby the woman has an elevated blood
pressure at 140/90 mmHg or greater recorded on two different occasions at least 4
hours apart. Proteinuria is absent.
Gestational hypertension
This occurs when expulsion of the products of conception occurs. Premature cervical
dilations. A cause of bleeding during pregnancy.
Cervical insufficiency
What length is considered a short cervix?
Less than 25 mm in length
True or false. Dehydration stimulates uterine contractions.
True
Client education for a pregnant woman experiencing cervical insufficiency. (3)
1. Client will be on activity restriction or bed rest.
2. Hydrate more, because dehydration stimulates uterine contractions.
,3. Avoid intercourse, tampons, and douching. Anything that can be inserted into the
vagina.
List two risk factors for cervical insufficiency.
1. History of cervical trauma (Cervical tears, excessive dilations, surgical procedures.)
2. Congenital structural defects
List four expected findings for cervical insufficiency.
1. Increase in pelvic pressure or urge to push.
2. Pink stained vaginal discharge or bleeding
3. Water may break
4. Miscarriage (Uterus contracts with the expulsion of the fetus)
Presence of cervical funneling
Beaking
Gestational diabetes mellitus (GDM)
An impaired tolerance to glucose with the first onset or recognition during pregnancy.
List four laboratory tests conducted on a pregnant woman who is suspected to have
GDM.
1. Routine urinalysis to test for glycosuria
2. 1 hour GTT
3. 3 hour oral GTT
4. Urinalysis to test for presence of ketones in urine
List three interventions for a patient who is experiencing gestational hypertension.
1. Antihypertensive medications
2. Diet
3. Exercise
What alteration in deep tendon reflexes is manifested in preeclampsia?
Hyperreflexia
What level is a positive 1-hour GTT?
Over 140 mg/dL
Do you have to fast for a 1-hour GTT?
No, but you do have to fast for a 3-hour GTT.
List three things you cannot do before a 3-hour GTT.
1. No eating 12 hours before test.
2. Do not drink caffeine.
3. Do not smoke 12 hr prior to testing.
, What are three diagnostic procedures that would be conducted on a patient with GDM
to assess fetal well-being?
1. BPP
2. Amniocentesis
3. NST
If a woman is diagnosed with GDM, what is the first pt. education provided to help treat
this?
Diet and exercise. If glucose levels are persistently high, insulin or oral hypoglycemia
therapy is begun.
Gestational hypertension begins after the ____ week of pregnancy.
20th
Gestational hypertension (>140/90) with the addition of proteinuria of greater than or
equal to 1+. Report of transient headaches might occur along with episodes or
irritability. Edema can be present.
Mild preeclampsia.
Consists of BP that is 160/110 mmHg or greater, proteinuria greater than 3+, oliguria,
elevated serum creatinine greater than 1.1 mg/dL, cerebral or visual disturbances
(headache and blurred vision), hyperreflexia with possible ankle clonus, extensive
peripheral edema, hepatic dysfunction, epigastric and right upper-quadrant pain, and
thrombocytopenia.
Severe preeclampsia
Severe preeclamptic manifestations with the onset of seizure activity or coma.
Eclampsia
Describe HELLP.
H: Hemolysis resulting in anemia and jaundice.
EL: Elevated liver enzymes, such as ALT, AST, including epigastric pain and nausea
and vomiting.
LP: Low platelets (Less than 100,000/mm3), resulting in thrombocytopenia. Results in
reduced clotting factors, causing manifestations such as bleeding gums.
List 7 risk factors related to gestational hypertensive disorders.
1. Abnormal maternal age (<19 or >40)
2. Prima gravida
3. Obesity
4. Having multiple fetuses
5. Chronic hypertension
6. Family history of preeclampsia
7. Having DM
What type of stomach pain is experienced in preeclampsia?
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