(Select all that apply).
A nurse is providing discharge teaching to a client with gestational hypertension who delivered a healthy baby two days ago.
Which of the following statements by the client would indicate a need for further teaching?
I should continue to take my blood pressure medication as prescribed until my next check-up
I should report any signs of headache, blurred vision, or abdominal pain to my provider
I should avoid breastfeeding my baby until my blood pressure returns to normal.
I should limit my salt intake and drink plenty of fluids.
I should weigh myself daily and report any sudden weight gain to my provider
Correct Answer : A,B,D,E
The correct answer is choice C. Choice C is wrong because breastfeeding is not contraindicated for women with gestational hypertension. Breastfeeding has many benefits for both the mother and the baby, and it does not affect blood pressure.
Choice A is correct because blood pressure medication should be continued as prescribed until the next check-up. Stopping medication abruptly can cause a rebound increase in blood pressure and increase the risk of complications.
Choice B is correct because headache, blurred vision, or abdominal pain are signs of severe preeclampsia, a serious complication of gestational hypertension that can affect the brain, liver, and kidneys. These symptoms should be reported to the provider immediately.
Choice D is correct because limiting salt intake and drinking plenty of fluids can help lower blood pressure and prevent fluid retention.
Salt can cause the body to hold on to excess water, which increases blood volume and blood pressure. Fluids can help flush out excess salt and keep the body hydrated.
Choice E is correct because weighing oneself daily and reporting any sudden weight gain to the provider can help monitor fluid balance and detect signs of preeclampsia. A weight gain of more than 2 pounds in a week or 5 pounds in a month may indicate fluid accumulation and increased blood pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is choice D. Have calcium gluconate available at the bedside as an antidote.Magnesium sulfate is used to prevent and treat seizures in women with severe preeclampsia or eclampsia.However, it can also cause toxicity and respiratory depression if the serum level is too high.Calcium gluconate is the antidote for magnesium sulfate toxicity and should be readily available at the bedside.
Choice A is wrong because the medication should be administered over 20-30 minutes using an infusion pump.
A shorter infusion time may increase the risk of adverse effects.
Choice B is wrong because the client should be placed in a lateral position to improve uteroplacental perfusion and reduce the risk of aspiration.
Choice C is wrong because the client’s blood pressure should be monitored every 5 minutes during the infusion, not every 15 minutes.
Blood pressure is an indicator of the severity of preeclampsia and the effectiveness of magnesium sulfate therapy.
Correct Answer is C
Explanation
The correct answer is choice C) Elevated serum bilirubin levels.This is because bilirubin is a product of hemolysis (the breakdown of red blood cells), which is one of the components of HELLP syndrome.Elevated serum bilirubin levels indicate that there is excessive hemolysis occurring in the body, which can lead to jaundice and liver damage.
Choice A) Elevated serum creatinine levels is wrong because creatinine is a marker of kidney function, not liver function or hemolysis.While kidney failure can occur as a complication of HELLP syndrome, it is not a diagnostic criterion.
Choice B) Elevated serum uric acid levels is wrong because uric acid is also a marker of kidney function, not liver function or hemolysis.Uric acid levels can be elevated in preeclampsia, but not specifically in HELLP syndrome.
Choice D) Elevated serum glucose levels is wrong because glucose is not related to liver function or hemolysis.Glucose levels can be elevated in gestational diabetes, but not in HELLP syndrome.
Normal ranges for these tests are:
• Serum bilirubin: 0.3 to 1.2 mg/dL
• Serum creatinine: 0.6 to 1.1 mg/dL
• Serum uric acid: 2.4 to 6.0 mg/dL
• Serum glucose: 70 to 100 mg/dL
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