Free Printable Preeclampsia Case Study Quiz

1.

A client with severe preeclampsia is prescribed magnesium sulfate. Which assessment is the priority before initiating the infusion?

a)

Blood glucose

b)

Deep tendon reflexes (DTRs)

c)

Bowel sounds

d)

Fundal height

2.

The nurse is administering magnesium sulfate 4 g IV bolus over 20 minutes, then 2 g/hr maintenance. Which finding indicates magnesium toxicity?

a)

BP 150/92

b)

Urine output 35 mL/hr

c)

Respiratory rate 10/min

d)

DTRs +2

3.

Which orders should the nurse anticipate for a client admitted with severe preeclampsia at 34 weeks?

a)

Magnesium sulfate infusion

b)

Betamethasone injections

c)

Oxytocin to induce labor immediately

d)

Continuous fetal monitoring

e)

IV antihypertensives

4.

A client on magnesium sulfate has absent patellar reflexes. What is the nurse’s first action?

a)

Increase IV fluids

b)

Stop magnesium and notify provider

c)

Reassess in 30 minutes

d)

Prepare for emergency C-section

5.

Which lab result is most concerning in preeclampsia?

a)

Platelets 85,000/mm³

b)

Hgb 12.5 g/dL

c)

WBC 11,000/mm³

d)

Sodium 138 mEq/L

6.

The nurse is caring for a preeclamptic client receiving magnesium sulfate. Which urine output requires calling the provider?

a)

40 mL/hr

b)

35 mL/hr

c)

25 mL/hr

d)

45 mL/hr

7.

Which findings are diagnostic of preeclampsia?

a)

New-onset HTN after 20 weeks

b)

Proteinuria

c)

Hypoglycemia

d)

Headache unrelieved by meds

e)

Elevated liver enzymes

8.

A client at 30 weeks has BP 168/110, RUQ pain, and blurred vision. What does this suggest?

a)

Mild gestational HTN

b)

Severe preeclampsia

c)

Chorioamnionitis

d)

Placenta previa

9.

Which medication is the antidote for magnesium sulfate toxicity?

a)

Naloxone

b)

Calcium gluconate

c)

Vitamin K

d)

Hydralazine

10.

The provider orders magnesium sulfate '2 g/hr.' The pharmacy sends 20 g in 500 mL LR. What rate should the nurse set?

a)

25 mL/hr

b)

50 mL/hr

c)

75 mL/hr

d)

100 mL/hr

11.

A 27-year-old G2P1 at 33+5 weeks arrives to L&D with swelling, severe headache, and visual spots. BP 170/112, RR 18, HR 96. Reflexes brisk +3 with 2-beat clonus. Urine dip 3+ protein. FHR baseline 150 with minimal variability. Labs: platelets 92,000, AST/ALT elevated, creatinine 1.3. Provider orders: magnesium sulfate 4 g loading, then 2 g/hr; labetalol IV PRN SBP >160; strict I&O; seizure precautions; continuous EFM; prepare for possible C-section. Client later requires emergency C-section for worsening FHR and maternal status.

Which provider order should the nurse implement first?

a)

Start magnesium sulfate loading dose

b)

Insert Foley and strict I&O

c)

Apply seizure precautions

d)

Begin continuous EFM

12.

A 27-year-old G2P1 at 33+5 weeks arrives to L&D with swelling, severe headache, and visual spots. BP 170/112, RR 18, HR 96. Reflexes brisk +3 with 2-beat clonus. Urine dip 3+ protein. FHR baseline 150 with minimal variability. Labs: platelets 92,000, AST/ALT elevated, creatinine 1.3. Provider orders: magnesium sulfate 4 g loading, then 2 g/hr; labetalol IV PRN SBP >160; strict I&O; seizure precautions; continuous EFM; prepare for possible C-section. Client later requires emergency C-section for worsening FHR and maternal status.

Which assessment finding requires immediate provider notification?

a)

Headache 6/10

b)

Minimal fetal variability

c)

3+ proteinuria

d)

Pedal edema

13.

A 27-year-old G2P1 at 33+5 weeks arrives to L&D with swelling, severe headache, and visual spots. BP 170/112, RR 18, HR 96. Reflexes brisk +3 with 2-beat clonus. Urine dip 3+ protein. FHR baseline 150 with minimal variability. Labs: platelets 92,000, AST/ALT elevated, creatinine 1.3. Provider orders: magnesium sulfate 4 g loading, then 2 g/hr; labetalol IV PRN SBP >160; strict I&O; seizure precautions; continuous EFM; prepare for possible C-section. Client later requires emergency C-section for worsening FHR and maternal status.

What nursing actions are appropriate during magnesium sulfate loading dose?

a)

Keep calcium gluconate available

b)

Monitor RR every 5–15 minutes

c)

Check DTRs frequently

d)

Encourage ambulation to prevent clots

e)

Continuous fetal monitoring

14.

A 27-year-old G2P1 at 33+5 weeks arrives to L&D with swelling, severe headache, and visual spots. BP 170/112, RR 18, HR 96. Reflexes brisk +3 with 2-beat clonus. Urine dip 3+ protein. FHR baseline 150 with minimal variability. Labs: platelets 92,000, AST/ALT elevated, creatinine 1.3. Provider orders: magnesium sulfate 4 g loading, then 2 g/hr; labetalol IV PRN SBP >160; strict I&O; seizure precautions; continuous EFM; prepare for possible C-section. Client later requires emergency C-section for worsening FHR and maternal status.

The nurse notes new epigastric/RUQ pain. This is concerning for:

a)

Normal uterine stretching

b)

HELLP syndrome progression

c)

Round ligament pain

d)

Braxton Hicks contractions

15.

A 27-year-old G2P1 at 33+5 weeks arrives to L&D with swelling, severe headache, and visual spots. BP 170/112, RR 18, HR 96. Reflexes brisk +3 with 2-beat clonus. Urine dip 3+ protein. FHR baseline 150 with minimal variability. Labs: platelets 92,000, AST/ALT elevated, creatinine 1.3. Provider orders: magnesium sulfate 4 g loading, then 2 g/hr; labetalol IV PRN SBP >160; strict I&O; seizure precautions; continuous EFM; prepare for possible C-section. Client later requires emergency C-section for worsening FHR and maternal status.

The client’s BP remains 166/108 after magnesium is started. What is the nurse’s priority?

a)

Raise the head of bed

b)

Give IV labetalol per order

c)

Stop magnesium infusion

d)

Offer oral fluids

16.

A 27-year-old G2P1 at 33+5 weeks arrives to L&D with swelling, severe headache, and visual spots. BP 170/112, RR 18, HR 96. Reflexes brisk +3 with 2-beat clonus. Urine dip 3+ protein. FHR baseline 150 with minimal variability. Labs: platelets 92,000, AST/ALT elevated, creatinine 1.3. Provider orders: magnesium sulfate 4 g loading, then 2 g/hr; labetalol IV PRN SBP >160; strict I&O; seizure precautions; continuous EFM; prepare for possible C-section. Client later requires emergency C-section for worsening FHR and maternal status.

FHR shows late decelerations and minimal variability. Best action?

a)

Reposition to left side and increase IV fluids

b)

Document and reassess in 30 minutes

c)

Prepare to discharge client

d)

Reduce magnesium dose

17.

A 27-year-old G2P1 at 33+5 weeks arrives to L&D with swelling, severe headache, and visual spots. BP 170/112, RR 18, HR 96. Reflexes brisk +3 with 2-beat clonus. Urine dip 3+ protein. FHR baseline 150 with minimal variability. Labs: platelets 92,000, AST/ALT elevated, creatinine 1.3. Provider orders: magnesium sulfate 4 g loading, then 2 g/hr; labetalol IV PRN SBP >160; strict I&O; seizure precautions; continuous EFM; prepare for possible C-section. Client later requires emergency C-section for worsening FHR and maternal status. The nurse is preparing the client for emergency C-section. Which statement best explains the indication?

a)

Your cervix isn’t dilating.

b)

Your baby is too premature for labor.

c)

Your baby is showing signs of distress and your condition is worsening.

d)

Magnesium sulfate requires a surgical birth.

18.

A 27-year-old G2P1 at 33+5 weeks arrives to L&D with swelling, severe headache, and visual spots. BP 170/112, RR 18, HR 96. Reflexes brisk +3 with 2-beat clonus. Urine dip 3+ protein. FHR baseline 150 with minimal variability. Labs: platelets 92,000, AST/ALT elevated, creatinine 1.3. Provider orders: magnesium sulfate 4 g loading, then 2 g/hr; labetalol IV PRN SBP >160; strict I&O; seizure precautions; continuous EFM; prepare for possible C-section. Client later requires emergency C-section for worsening FHR and maternal status. In the OR, what are the nurse’s roles for this preeclamptic client?

a)

Maintain seizure precautions

b)

Monitor BP and oxygenation closely

c)

Position to avoid supine hypotension

d)

Give IV push opioids without orders

e)

Prepare neonatal resuscitation team

19.

A 27-year-old G2P1 at 33+5 weeks arrives to L&D with swelling, severe headache, and visual spots. BP 170/112, RR 18, HR 96. Reflexes brisk +3 with 2-beat clonus. Urine dip 3+ protein. FHR baseline 150 with minimal variability. Labs: platelets 92,000, AST/ALT elevated, creatinine 1.3. Provider orders: magnesium sulfate 4 g loading, then 2 g/hr; labetalol IV PRN SBP >160; strict I&O; seizure precautions; continuous EFM; prepare for possible C-section. Client later requires emergency C-section for worsening FHR and maternal status.

Post-op, which assessment is most critical in the first hour?

a)

Lochia amount

b)

Respiratory status and reflexes

c)

Incision dressing type

d)

Bowel sounds

20.

A 27-year-old G2P1 at 33+5 weeks arrives to L&D with swelling, severe headache, and visual spots. BP 170/112, RR 18, HR 96. Reflexes brisk +3 with 2-beat clonus. Urine dip 3+ protein. FHR baseline 150 with minimal variability. Labs: platelets 92,000, AST/ALT elevated, creatinine 1.3. Provider orders: magnesium sulfate 4 g loading, then 2 g/hr; labetalol IV PRN SBP >160; strict I&O; seizure precautions; continuous EFM; prepare for possible C-section. Client later requires emergency C-section for worsening FHR and maternal status.

Which post-op finding should be reported immediately?

a)

UO 20 mL/hr

b)

BP 148/90

c)

DTRs +1

d)

Pain 4/10

21.

Which client is at highest risk for preeclampsia?

a)

Multipara age 28, no history

b)

Primigravida age 19

c)

G1 age 36 with chronic HTN

d)

G3 age 30 with iron-deficiency anemia

22.

Risk factors for preeclampsia include:

a)

Multiple gestation

b)

Diabetes mellitus

c)

History of preeclampsia

d)

Smoking

e)

Obesity

23.

A preeclamptic client reports 'I feel like I can’t catch my breath.' Lungs have crackles. What complication is suspected?

a)

Amniotic fluid embolism

b)

Pulmonary edema

c)

Placental abruption

d)

Hypovolemia

24.

A client on magnesium sulfate has RR 14, UO 32 mL/hr, DTRs +2. What should the nurse do?

a)

Continue infusion

b)

Stop infusion

c)

Give calcium gluconate

d)

Call rapid response

25.

Which symptom in a preeclamptic client indicates possible impending eclampsia?

a)

Mild edema

b)

Hyperreflexia and clonus

c)

Heartburn after meals

d)

Increased appetite

26.

Preeclampsia pathophysiology is primarily related to:

a)

Placental perfusion problems causing endothelial damage

b)

Maternal hypoglycemia

c)

Infection of the amniotic sac

d)

Increased fetal insulin

27.

Which BP requires calling the provider immediately in preeclampsia?

a)

142/86

b)

150/92

c)

162/108

d)

148/88

28.

A client receiving magnesium sulfate becomes lethargic and difficult to arouse. First nursing action?

a)

Check serum magnesium level and RR

b)

Offer juice

c)

Increase infusion rate

d)

Place in Trendelenburg

29.

Appropriate seizure precautions for severe preeclampsia:

a)

Pad side rails

b)

Suction and O2 at bedside

c)

Keep room dark/quiet

d)

Restrict all fluids completely

e)

Maintain IV access

30.

A client with preeclampsia asks why she needs strict I&O. Best response:

a)

It helps us monitor kidney function and fluid balance.

b)

It’s routine for all pregnancies.

c)

To reduce heartburn.

d)

To prevent nausea.

31.

Which lab trend indicates worsening preeclampsia?

a)

Platelets rising from 110k to 150k

b)

AST rising from 40 to 120

c)

Creatinine decreasing to 0.7

d)

Hct stable at 35%

32.

Which statement by a postpartum client with preeclampsia needs teaching?

a)

I’ll call if I get a bad headache.

b)

Preeclampsia can worsen after delivery.

c)

Once the baby is out, I don’t need monitoring.

d)

I should report vision changes.

33.

Postpartum nursing actions for preeclampsia include:

a)

Continue magnesium for 24 hr

b)

Monitor for hemorrhage

c)

Assess neuro status frequently

d)

Encourage high-sodium foods

e)

Monitor BP closely

34.

A client with severe preeclampsia has a seizure. What is the nurse’s priority?

a)

Insert oral airway

b)

Turn client to side and protect from injury

c)

Start IV oxytocin

d)

Check cervical dilation

35.

After a seizure, which medication should the nurse expect to administer?

a)

Terbutaline

b)

Magnesium sulfate bolus

c)

Methylergonovine

d)

Misoprostol

36.

Gate control theory suggests that pain transmission can be reduced by:

a)

Increasing uterine stimulation

b)

Closing the 'gate' via competing sensory input

c)

Preventing all touch during labor

d)

Keeping client NPO

37.

Non-pharmacologic techniques based on gate control theory include:

a)

Massage

b)

Counter-pressure

c)

Slow paced breathing

d)

Ice packs or warm compresses

e)

Fetal scalp electrode placement

38.

A laboring client requests an epidural. Which assessment is most important prior to placement?

a)

FHR baseline

b)

Platelet count

c)

Fundal height

d)

Amniotic fluid color

39.

Which is a common side effect of epidural anesthesia?

a)

Hypertension

b)

Maternal hypotension

c)

Hyperreflexia

d)

Tachypnea

40.

After epidural placement, which nursing intervention is priority?

a)

Encourage ambulation

b)

Monitor BP frequently

c)

Perform vaginal exam hourly

d)

Keep client supine flat

41.

A client with epidural reports ringing in ears and metallic taste. What is suspected?

a)

Hypoglycemia

b)

Local anesthetic toxicity

c)

Hyperventilation

d)

Normal effect

42.

Nursing actions to manage epidural-related hypotension:

a)

Left lateral positioning

b)

Rapid IV fluid bolus per protocol

c)

O2 via face mask

d)

Increase oxytocin

e)

Notify anesthesia/provider

43.

A client has an epidural and cannot feel the urge to void. Best nursing action?

a)

Encourage fluids

b)

Straight cath or Foley per order

c)

Place warm pack on bladder

d)

Wait until delivery

44.

Which statement shows correct understanding of pharmacologic pain relief in labor?

a)

IV opioids won’t affect the baby.

b)

Epidurals can slow my BP so you’ll watch it.

c)

I can walk freely right after an epidural.

d)

Nitrous oxide is only for C-sections.

45.

A client given IV opioids during active labor becomes drowsy and RR 8/min. Priority action?

a)

Reposition

b)

Stop opioid and give naloxone per protocol

c)

Check cervix

d)

Offer ice chips

46.

(SATA) When should the nurse call the provider for a client with epidural anesthesia?

a)

BP drops to 88/50

b)

FHR late decelerations occur

c)

Client has unilateral numbness only

d)

Maternal fever 101.5°F (38.6°C)

e)

Client reports severe headache after birth

47.

A client in labor uses breathing and focal point techniques. These actions primarily:

a)

Increase uterine perfusion only

b)

Provide distraction and reduce pain perception

c)

Stop contractions

d)

Replace need for all meds

48.

Best position for a client after epidural to optimize placental perfusion?

a)

Supine with legs straight

b)

Left lateral with wedge

c)

Prone

d)

High Fowler’s

49.

A laboring preeclamptic client with epidural complains of sudden severe abdominal pain and firm uterus. Priority concern?

a)

Placental abruption

b)

Normal transition phase

c)

Epidural wearing off

d)

UTI

50.

(SATA) Correct nursing care for laboring client receiving magnesium sulfate includes:

a)

Continuous EFM

b)

Assess RR, DTRs, UO regularly

c)

Keep client in quiet/dim environment

d)

Encourage pushing as soon as contractions start

e)

Have calcium gluconate available

Preeclampsia Case Study Quiz

Total questions: 50

Worksheet time: 26mins

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