A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse?
Dipstick value of 3+ for protein in her urine
Pitting pedal edema at the end of the day
Weight gain of 0.5 kg during the past 2 weeks
Blood pressure (BP) increase to 138/86 mm Hg
The Correct Answer is A
Choice A reason: Dipstick value of 3+ for protein in her urine is a sign of significant proteinuria, which is one of the diagnostic criteria for preeclampsia, along with hypertension. Proteinuria indicates renal damage and impaired glomerular filtration, which can lead to complications, such as oliguria, eclampsia, or HELLP syndrome.
Choice B reason: Pitting pedal edema at the end of the day is a common and expected finding in pregnancy, as it results from the increased blood volume, venous pressure, and fluid retention. Edema is not a reliable indicator of preeclampsia, unless it is severe, generalized, or sudden.
Choice C reason: Weight gain of 0.5 kg during the past 2 weeks is a normal and expected finding in pregnancy, as it reflects the growth and development of the fetus, placenta, and maternal tissues. Weight gain is not a reliable indicator of preeclampsia, unless it is excessive, rapid, or associated with edema.
Choice D reason: Blood pressure (BP) increase to 138/86 mm Hg is a mild elevation that may indicate gestational hypertension, but not preeclampsia, unless it is accompanied by proteinuria or other signs of organ dysfunction. The diagnostic threshold for preeclampsia is a BP of 140/90 mm Hg or higher on two occasions at least four hours apart.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Misoprostol is not the first line medication for postpartum hemorrhage, as it is a prostaglandin E1 analog that causes uterine contractions and cervical ripening. Misoprostol is used for the prevention and treatment of postpartum hemorrhage, but it is less effective and more side effects than oxytocin, which is the first line medication.
Choice B reason: Pitocin is the first line medication for postpartum hemorrhage, as it is a synthetic form of oxytocin, which is a hormone that stimulates uterine contractions and retraction. Pitocin is used for the induction and augmentation of labor, and the prevention and treatment of postpartum hemorrhage, as it reduces blood loss and enhances hemostasis.
Choice C reason: Hemabate is not the first line medication for postpartum hemorrhage, as it is a prostaglandin F2 alpha analog that causes uterine contractions and vasoconstriction. Hemabate is used for the treatment of postpartum hemorrhage, but it is contraindicated in clients with asthma, hypertension, or cardiac disease, as it can cause bronchospasm, hypertension, or cardiac arrhythmias.
Choice D reason: Methergine is not the first line medication for postpartum hemorrhage, as it is an ergot alkaloid that causes sustained uterine contractions and vasoconstriction. Methergine is used for the treatment of postpartum hemorrhage, but it is contraindicated in clients with hypertension, preeclampsia, or cardiac disease, as it can cause severe hypertension, cerebrovascular accidents, or myocardial infarction.
Correct Answer is B
Explanation
Choice A reason: Increased risk of anemia is not a likely cause of respiratory distress in a term macrosomic newborn, as it can affect any newborn regardless of the maternal diabetes status or the fetal size. Anemia can cause pallor, tachycardia, and poor feeding, but not respiratory distress.
Choice B reason: Hyperinsulinemia is a likely cause of respiratory distress in a term macrosomic newborn, as it results from the fetal exposure to high maternal glucose levels and the subsequent overproduction of insulin. Hyperinsulinemia can impair the synthesis of surfactant, which is a substance that prevents the alveoli from collapsing and facilitates gas exchange. Hyperinsulinemia can also cause hypoglycemia, which can affect the respiratory center and cause apnea.
Choice C reason: Increased blood viscosity is not a likely cause of respiratory distress in a term macrosomic newborn, as it can affect any newborn with polycythemia, which is an abnormally high number of red blood cells. Polycythemia can cause cyanosis, jaundice, and thrombosis, but not respiratory distress.
Choice D reason: Brachial plexus injury is not a likely cause of respiratory distress in a term macrosomic newborn, as it affects the nerves that supply the arm and hand, not the lungs. Brachial plexus injury can occur due to the excessive traction or stretching of the shoulder during delivery, and can cause weakness, paralysis, or sensory loss in the affected arm.
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