A nurse is caring for a client who has severe preeclampsia and is receiving hydralazine IV bolus for blood pressure management.

Which of the following adverse effects should the nurse monitor for? (Select all that apply.)

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.

The correct answer is choice A and B. Hydralazine is a drug that lowers blood pressure by relaxing the blood vessels.It can cause some side effects such astachycardia(fast heart rate) andheadache.

These are common and may go away during treatment.

However, if they are severe or persistent, the nurse should monitor the client and report to the doctor.

Choice C is wrong because nausea is not a common side effect of hydralazine.

It may be caused by other factors such as pregnancy or infection.

Choice D is wrong because hyperkalemia (high potassium level in the blood) is not a side effect of hydralazine.

It may be caused by other drugs such as angiotensin-converting enzyme inhibitors or potassium-sparing diuretics.

Choice E is wrong because oliguria (low urine output) is not a side effect of hydralazine.

It may be a sign of kidney damage or dehydration.

The nurse should monitor the client’s fluid intake and output and report any changes to the doctor.