Signs and symptoms of preeclampsia with severe features include (Select all that apply):
Elevated liver function tests
Unremitting headache
Rising protein in sequential 24-hour urine
Increased urine output
Pain in the left upper quadrant
BP > 160/110
Correct Answer : A,B,C,E,F
Choice A: Elevated liver function tests indicate liver damage, which is a complication of preeclampsia with severe features.
Choice B: Unremitting headache is a sign of increased intracranial pressure, which can result from cerebral edema or hemorrhage caused by preeclampsia with severe features.
Choice C: Rising protein in sequential 24-hour urine reflects the degree of glomerular damage and renal impairment caused by preeclampsia with severe features.
Choice D: Increased urine output is not a sign of preeclampsia with severe features. In fact, oliguria (decreased urine output) may occur due to reduced renal perfusion and acute kidney injury.
Choice E: Pain in the left upper quadrant is a sign of splenic rupture or subcapsular hematoma, which are rare but life-threatening complications of preeclampsia with severe features.
Choice F: BP > 160/110 is one of the diagnostic criteria for preeclampsia with severe features, as it indicates severe hypertension and increased risk of maternal and fetal complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. "You are far enough along that your baby will be just finE." This is not a good response because it is dismissive of the client's concerns and does not provide any factual information or reassurancE. The nurse should not make false promises or minimize the client's feelings.
B. "Everyone worries about their baby while they are in labor." This is not a good response because it is generalizing and does not address the client's specific situation. The nurse should not compare the client to others or imply that their worries are normal or insignificant.
D. "We have a neonatal unit here equipped to handle emergencies." This is not a good response because it implies that there is a high risk of complications and may increase the client's anxiety. The nurse should not focus on negative outcomes or scare the client with unnecessary information.
Correct Answer is B
Explanation
Choice A reason: This is not the most concerning vital sign because a heart rate of 99 is within the normal range for an adult. The nurse should monitor the patient's heart rate and rhythm, but it is not a sign of magnesium toxicity or adverse effects.
Choice B reason: This is the most concerning vital sign because a respiratory rate of 9 is below the normal range for an adult and indicates respiratory depression, which is a sign of magnesium toxicity. The nurse should stop the infusion, notify the provider, and prepare to administer calcium gluconate as an antidotE.
Choice C reason: This is not the most concerning vital sign because a BP of 99/69 is within the normal range for an adult. The nurse should monitor the patient's blood pressure and fluid status, but it is not a sign of magnesium toxicity or adverse effects.
Choice D reason: This is not the most concerning vital sign because a temperature of 99.9 is within the normal range for an adult. The nurse should monitor the patient's temperature and infection signs, but it is not a sign of magnesium toxicity or adverse effects.
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