The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse expect to observe? (Select all that apply)

Seizure activity and hypotension

Platelet count of less than 100,000/mm3 and visual problems

Ankle clonus and epigastric pain

Decreased urinary output and irritability

Answer and Explanation

Correct Answer : B,C,D

Choice A reason: Seizure activity and hypotension are not signs and symptoms of severe preeclampsia, but rather of eclampsia, which is a life-threatening complication of preeclampsia. Eclampsia is characterized by convulsions and coma, and it requires immediate treatment to prevent maternal and fetal death.

Choice B reason: Platelet count of less than 100,000/mm3 and visual problems are signs and symptoms of severe preeclampsia, as they indicate hematologic and neurologic complications. Severe preeclampsia can cause thrombocytopenia, which is a low platelet count that increases the risk of bleeding. It can also cause cerebral edema, which can impair the vision and cause blurred vision, spots, or flashes of light.

Choice C reason: Ankle clonus and epigastric pain are signs and symptoms of severe preeclampsia, as they indicate neuromuscular and hepatic complications. Severe preeclampsia can cause hyperreflexia, which is an exaggerated reflex response that can be elicited by dorsiflexing the ankle and observing rhythmic jerking of the foot. It can also cause liver damage, which can manifest as epigastric pain or right upper quadrant pain.

Choice D reason: Decreased urinary output and irritability are signs and symptoms of severe preeclampsia, as they indicate renal and central nervous system complications. Severe preeclampsia can cause oliguria, which is a reduced urine output of less than 500 mL in 24 hours. It can also cause increased intracranial pressure, which can affect the mood and behavior and cause irritability, anxiety, or confusion.

Choice E reason: Transient headache and +1 proteinuria are not signs and symptoms of severe preeclampsia, but rather of mild preeclampsia, which is a less severe form of the condition. Mild preeclampsia is characterized by blood pressure of 140/90 mm Hg or higher, proteinuria of 1+ or higher, and mild edema. It does not cause severe complications or organ damage, but it can progress to severe preeclampsia if not treated.

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Correct Answer is A

Explanation

Choice A reason: HSV-2 is a viral infection that causes genital herpes. It is transmitted through sexual contact and can cause painful blisters and ulcers in the genital area. The primary infection is usually the most severe and lasts for several weeks. After the primary infection, the virus remains dormant in the nerve cells and can reactivate periodically, causing recurrent episodes of genital herpes. The frequency and severity of the recurrences vary from person to person.

Choice B reason: HPV is a viral infection that causes genital warts and cervical cancer. It is transmitted through sexual contact and can infect the skin and mucous membranes of the genital area. The primary infection is often asymptomatic and may clear spontaneously or persist for years. HPV does not cause recurrent episodes of genital warts or cervical cancer, but it can increase the risk of developing these conditions over time.

Choice C reason: CMV is a viral infection that causes flu-like symptoms and can affect various organs. It is transmitted through bodily fluids such as saliva, urine, blood, and semen. The primary infection is usually mild and may go unnoticed. After the primary infection, the virus remains latent in the body and can reactivate in people with weakened immune systems, causing serious complications. CMV does not cause recurrent episodes of flu-like symptoms or organ damage, but it can worsen the condition of people with HIV or AIDS.

Choice D reason: HIV is a viral infection that causes acquired immunodeficiency syndrome (AIDS). It is transmitted through sexual contact, blood transfusion, or sharing of needles. The primary infection is often accompanied by flu-like symptoms and lasts for a few weeks. After the primary infection, the virus gradually destroys the immune system and makes the person vulnerable to opportunistic infections and cancers. HIV does not cause recurrent episodes of flu-like symptoms or AIDS, but it can progress to AIDS over time.

A. Blood pressure (BP) increase to 138/86 mm Hg. B. Pitting pedal edema at the end of the day. C. Weight gain of 0.5 kg during the past 2 weeks. D. A dipstick value of 3+ for protein in her urine.

Correct Answer is D

Explanation

Choice A reason: A blood pressure increase to 138/86 mm Hg is not a concerning finding for preeclampsia. The diagnostic criteria for preeclampsia include a BP of 140/90 mm Hg or higher on two occasions at least 4 hours apart, or a BP of 160/110 mm Hg or higher on one occasion.

Choice B reason: Pitting pedal edema at the end of the day is not a concerning finding for preeclampsia. Edema is a common symptom of pregnancy and can be influenced by factors such as hydration, activity, and posture. Edema is not a reliable indicator of preeclampsia.

Choice C reason: Weight gain of 0.5 kg during the past 2 weeks is not a concerning finding for preeclampsia. The recommended weight gain for a normal-weight woman during pregnancy is 11.5 to 16 kg, with an average of 0.4 kg per week in the second and third trimesters.

Choice D reason: A dipstick value of 3+ for protein in her urine is a concerning finding for preeclampsia. Proteinuria is one of the hallmark signs of preeclampsia and indicates renal impairment. A dipstick value of 3+ corresponds to a protein concentration of 300 mg/dL or higher, which is considered severe.

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The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse expect to observe? (Select all that apply)

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The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse expect to observe? (Select all that apply)