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WorksheetsOLIVIA JONES- SEVERE PREECLAMPSIA
Total questions: 16
Worksheet time: 48mins
Which of the entries on a patient's medical record are evidence of the diagnosis of severe preeclampsia? (Select all that apply.)
Oliguria
Blood pressure 182/116 mmHg
3 lb (1.4 kg) weight gain in 1 week
Epigastric pain
Negative urine ketones
Which of the following need to be implemented when a patient with severe preeclampsia is admitted to the hospital? (Select all that apply.)
Television for entertainment
Bed rest in a left lateral lying position
Frequent visitors for diversion and support
Seizure precautions
Dim lighting
What are the priorities of care if a pregnant woman experiences an eclamptic seizure? (Select all that apply.)
Administer oxygen
Protect the patient from injury
Clear the airway
Insert a bite block to protect the tongue
Begin a cesarean birth immediately
Patients with severe preeclampsia are at risk for developing acute pulmonary edema. What can the nurse do to prevent the development of this condition?
Use the incentive spirometer every 2 hours
Monitor the patient's SpO2 levels
Administer oxygen continuously
Control the rate of administration of intravenous (IV) fluids
Which of the following findings from the nurse's assessment of the patient with severe preeclampsia would indicate central nervous system involvement? (Select all that apply.)
Absent deep tendon reflexes (DTRs)
4+ deep tendon reflexes (DTRs)
Positive clonus
Visual changes
Negative clonus
Ms. Jones's magnesium sulfate infusion is started. How does the nurse assess the effectiveness of the magnesium sulfate treatment?
Monitor blood pressure
Monitor urine output
Monitor deep tendon reflexes (DTRs)
Monitor uterine contractions
Which of the following need to be implemented when a patient with severe preeclampsia is admitted to the hospital? (Select all that apply.)
Television for entertainment
Bed rest in a left lateral lying position
Frequent visitors for diversion and support
Seizure precautions
Dim lighting
Ms. Jones is complaining of nausea and RUQ pain. Which set of labs would the nurse expect the provider to order based on her symptoms?
BUN, creatinine, uric acid
Complete blood count (CBC), platelet count, fibrinogen level
24-hour urine collection for protein, bile, and creatinine
Lactate dehydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST)
A review of Ms. Jones's lab results reveals thrombocytopenia. Based on this information, which of the following nursing actions is important while caring for this patient?
Have 2 units of packed red blood cells (PRBC) cross-match available in the blood bank
Apply firm pressure to puncture sites for 2 minutes
Place an ampule of vitamin K at the bedside
Obtain an order to administer steroids
After admitting Ms. Jones, the nurse calls the provider. What data would the nurse include in the situation-background-assessment-recommendation (SBAR) communications? (Select all that apply.)
Clonus 1+
Mother thinks her daughter is having a heart attack
Patient is scared
Coarse crackles in lungs
Severe headache
Ms. Jones tells the nurse she has severe pain under her right breast and asks, "Do you think I am having a heart attack?" What is the nurse's best response?
No, you are too young to be having a heart attack. It is just pressure from the growing baby in your belly.
The incidence of heart attacks is higher in African-American women, so I will ask the provider to come and check you.
No, you are having epigastric pain, which is caused by decreased blood flow to your liver because of your high blood pressure.
No, you are having epigastric pain because of an excess of toxins that have accumulated in your liver as a result of the pregnancy.
Monitoring Ms. Jones's liver enzymes, chemistry panel, and coagulation studies will assist the nurse to determine if the patient's condition is progressing to what?
Adult respiratory distress syndrome
Disseminated intravascular coagulation (DIC)
Eclampsia
HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome
A patient with preeclampsia is admitted with vital signs as follows: Temperature 98.6 F (37 C), heart rate 110 beats per minute (bpm), respiratory rate 28 breaths per minute, blood pressure 182/116 mmHg, Sp)2 92%. The fetal heart rate (FHR) is 150 bpm. Which of the following interventions would the nurse implement based on these findings?
Get an order for an antipyretic
Administer oxygen
Increase the IV fluid rate
Stimulate the fetus
What is the therapeutic blood level for a patient receiving an IV infusion of magnesium sulfate?
10 to 15 mEq/L
Over 15 mEq/L
8 to 10 mEq/L
4 to 7 mEq/L
Ms. Jones's mother asks the nurse if preeclampsia can be cured. What is the most appropriate response by the nurse?
With the technology available today, we can cure everything.
Birth of the infant is the only cure.
Treatment is individualized so I really can't say.
It can't be cured, but we can treat the symptoms.
(a) is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. It usually begins after 20 weeks of pregnancy in women whose blood pressure had been normal.
