Which blood pressure (BP) finding during the second trimester indicates a risk for pregnancy-induced hypertension?

Baseline BP 140/85, current BP 129/80

Baseline BP 110/70, current BP 145/85

Baseline BP 120/80, current BP 126/85

Baseline BP 110/60, current BP 120/63

Answer and Explanation

The Correct Answer is B

Choice A rationale
This is incorrect because a decrease in BP from the baseline is not a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 140/85 mm Hg indicates pre-existing hypertension, which may or may not worsen during pregnancy. A current BP of 129/80 mm Hg indicates an improvement in the BP control, but not a risk for pregnancy-induced hypertension.

Choice B rationale
This is correct because an increase in BP from the baseline by 30 mm Hg systolic or 15 mm Hg diastolic is a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 110/70 mm Hg indicates a normal BP before pregnancy. A current BP of 145/85 mm Hg indicates a significant elevation in the BP, which could lead to complications such as preeclampsia, eclampsia, or placental abruption.

Choice C rationale
This is incorrect because a slight increase in BP from the baseline is not a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 120/80 mm Hg indicates a normal BP before pregnancy. A current BP of 126/85 mm Hg indicates a minor elevation in the BP, which is within the normal range and does not pose a risk for pregnancy-induced hypertension.

Choice D rationale
This is incorrect because a slight increase in BP from the baseline is not a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 110/60 mm Hg indicates a normal BP before pregnancy. A current BP of 120/63 mm Hg indicates a minor elevation in the systolic BP, but a decrease in the diastolic BP, which is within the normal range and does not pose a risk for pregnancy-induced hypertension.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is B

Explanation

Choice A rationale
Gestational hypertension is not the most likely diagnosis for the client. Gestational hypertension is a condition where the blood pressure is elevated after 20 weeks of gestation, without any signs of proteinuria or end-organ damage. The client has a history of chronic hypertension for 5 years, which means that the hypertension existed before the pregnancy. The client also has proteinuria, which is a sign of preeclampsia.

Choice B rationale
Chronic hypertension with superimposed preeclampsia is the most likely diagnosis for the client. Chronic hypertension with superimposed preeclampsia is a condition where the blood pressure is elevated before 20 weeks of gestation, and the hypertension worsens or the proteinuria develops or increases after 20 weeks of gestation. The client has a history of chronic hypertension for 5 years, and the blood pressure is very high at 34 weeks of gestation. The client also has 3+ proteinuria, which indicates severe preeclampsia.

Choice C rationale
Eclampsia is not the most likely diagnosis for the client. Eclampsia is a condition where the preeclampsia progresses to cause seizures or coma in the pregnant woman. The client has no signs of seizures or coma, but only signs of preeclampsia.

Choice D rationale
HELLP syndrome is not the most likely diagnosis for the client. HELLP syndrome is a condition where the preeclampsia causes hemolysis, elevated liver enzymes, and low platelets in the pregnant woman. The client has no signs of hemolysis, liver damage, or thrombocytopenia, but only signs of preeclampsia.

A. Unstageable B. Stage 2 C. Deep tissue injury D. Stage 1

Correct Answer is A

Explanation

Choice A:

This is the correct choice. An unstageable pressure ulcer is a wound that has full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. The blackened area in the center of the wound suggests the presence of eschar.

Choice B:

A stage 2 pressure ulcer involves partial-thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. This does not match the description of the wound.

Choice C:

Deep tissue injury is a pressure-related injury to subcutaneous tissues under intact skin. Initially, these lesions have the appearance of a deep bruise. This does not match the description of the wound.

Choice D:

A stage 1 pressure ulcer is characterized by intact skin with non-blanchable redness of a localized area usually over a bony prominence. The skin may be painful, firm, soft, warmer, or cooler as compared to adjacent tissue. This does not match the description of the wound.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Which blood pressure (BP) finding during the second trimester indicates a risk for pregnancy-induced hypertension?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is B

Explanation

The patient has an area over the sacrum that is reddened around the edges with a blackened area in the center. How would you document this wound?

Correct Answer is A

Explanation

A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not." Which of the following should the nurse recognize as a sign of true labor?

A nurse is assessing a client who is pregnant for preeclampsia. Which of the following findings should indicate to the nurse that the client requires further evaluation for this disorder?

A nurse is caring for a client who is in active labor and notes late decelerations in the FHR. Which of the following actions should the nurse take first?

A nurse is preparing to administer methylergonovine IM to a client who experienced a vaginal delivery. The nurse should explain to the client that the purpose of this medication is to prevent which of the following conditions?

A nurse is caring for a term macrosomic newborn whose mother has poorly controlled type 2 diabetes. The newborn has respiratory distress syndrome. The nurse should be aware that the most likely cause of the respiratory distress is which of the following?

A nurse in an antepartum unit is triaging clients. Which of the following clients should the nurse see first?

A nurse is preparing to measure the fundal height of a client who is at 22 weeks of gestation. At which location should the nurse expect to palpate the fundus?