Review Practice Exercise 6

Hypertensive Disorders > Maternal Newborn

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Practice Exercise 6

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Question 1:

A nurse is caring for a patient with eclampsia. What is the priority action during a seizure?

A. Administer antihypertensive medication B. Protect the airway and ensure safety C. Perform a non-stress test D. Initiate corticosteroid therapy

Answer and Explanation

Choice A:

Antihypertensive medication is important in eclampsia, but not the priority during an active seizure. Blood pressure control is secondary to airway protection and seizure cessation. Administering labetalol or hydralazine is appropriate after stabilization. Giving medication during convulsions risks aspiration and is not immediately life-saving.

Choice B:

During an eclamptic seizure, the most critical intervention is to maintain airway patency and prevent trauma. Seizures compromise ventilation and increase aspiration risk. The nurse must position the patient in left lateral decubitus, clear the airway, and pad bedrails. This action directly prevents hypoxic injury and maternal-fetal compromise.

Choice C:

A non-stress test evaluates fetal well-being but is irrelevant during a seizure. The fetus may experience transient bradycardia due to maternal hypoxia. However, maternal stabilization takes precedence. Fetal monitoring is deferred until the mother is stable and seizure activity has ceased.

Choice D:

Corticosteroids are used to accelerate fetal lung maturity in preterm gestation, especially before 34 weeks. However, they do not address seizure control or maternal safety. Administering steroids during a seizure is not feasible and does not mitigate immediate risks like hypoxia or aspiration.

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Question 2:

What is the primary cause of seizures in eclampsia?

A. Hypoglycemia B. Cerebral vasospasm and edema C. Electrolyte imbalance D. Hypocalcemia

Answer and Explanation

Choice A:

Hypoglycemia can cause seizures, but it is not the mechanism in eclampsia. Blood glucose levels in eclampsia are typically normal. The seizures are due to vascular and neurological changes, not metabolic derangements. Hypoglycemia-induced seizures present differently and are not associated with hypertension or proteinuria.

Choice B:

Seizures in eclampsia are primarily caused by cerebral vasospasm and edema, which impair cerebral perfusion and increase neuronal excitability. Vasospasm leads to ischemia, while edema disrupts the blood-brain barrier. These changes provoke cortical irritation and seizure activity. PRES is a common radiologic finding confirming this mechanism.

Choice C:

Electrolyte imbalance, such as hyponatremia or hypernatremia, may cause seizures, but this is not the primary cause in eclampsia. Serum electrolytes are usually within normal limits unless complicated by renal dysfunction. The dominant pathology is cerebral edema, not ionic shifts.

Choice D:

Hypocalcemia can cause tetany and seizures, but it is not implicated in eclampsia. Calcium levels are not typically low in preeclampsia or eclampsia. The seizures stem from vascular instability and brain edema, not calcium deficiency.

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Question 3:

Which of the following interventions are appropriate for a patient with eclampsia during a seizure? Select all that apply

A. Turn the patient to the side B. Restrain the patient’s limbs C. Administer magnesium sulfate D. Protect the airway E. Insert an oral airway

Answer and Explanation

Choice A:

Turning the patient to the side reduces the risk of aspiration by allowing secretions to drain from the mouth and improves venous return by relieving pressure on the inferior vena cava. This position also helps maintain airway patency during convulsions.

Choice B:

Restraining the patient’s limbs is contraindicated during a seizure. It increases the risk of musculoskeletal injury and does not prevent seizure activity. Instead, the nurse should ensure a safe environment by padding bedrails and removing nearby objects without physically restraining the patient.

Choice C:

Administering magnesium sulfate is the first-line treatment for seizure control in eclampsia. It acts as a central nervous system depressant, reducing neuronal excitability and preventing recurrent seizures. The loading dose is typically 4 g IV over 20 minutes, followed by a maintenance infusion.

Choice D:

Protecting the airway is critical during a seizure to prevent hypoxia and aspiration. This includes positioning, suctioning secretions, and providing supplemental oxygen. Airway protection takes precedence over all other interventions during active convulsions.

Choice E:

Inserting an oral airway during an active seizure is dangerous and should be avoided. Attempting to place anything in the mouth during convulsions can cause oral trauma or airway obstruction. Airway adjuncts should only be inserted after the seizure has ended and the jaw is relaxed.

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Question 4:

Magnesium sulfate is commonly administered to pregnant women with preeclampsia for which primary purpose?

A. To lower blood pressure B. To induce labor C. To prevent seizures D. To enhance fetal lung maturity

Answer and Explanation

Choice A:

Magnesium sulfate does not lower blood pressure. It has mild vasodilatory effects but is not used for hypertension control. Labetalol, hydralazine, or nifedipine are preferred antihypertensives in preeclampsia. Magnesium’s role is anticonvulsant, not antihypertensive.

Choice B:

Magnesium sulfate does not induce labor. In fact, it may cause uterine relaxation and delay contractions. Oxytocin or prostaglandins are used for labor induction. Magnesium is used to prevent seizures, not to initiate delivery.

Choice C:

Magnesium sulfate is administered to prevent seizures in patients with preeclampsia and to treat seizures in eclampsia. It stabilizes neuronal membranes and reduces cortical irritability. It is not an antihypertensive or uterotonic agent. Its primary role is neuroprotection.

Choice D:

Magnesium sulfate does not enhance fetal lung maturity. Corticosteroids such as betamethasone are used for that purpose before 34 weeks gestation. Magnesium may offer neuroprotection to the fetus but does not accelerate lung development.

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Question 5:

When providing care for a client receiving magnesium sulfate for preeclampsia, which of the following assessments are essential to monitor for potential toxicity? Select all that apply

A. Deep tendon reflexes B. Urine output C. Blood glucose levels D. Respiratory rate E. Fetal heart rate baseline variability

Answer and Explanation

Choice A:

Monitoring deep tendon reflexes is essential because their absence is an early sign of magnesium toxicity. The patellar reflex is typically assessed every hour. Reflex suppression indicates excessive neuromuscular blockade and precedes respiratory compromise.

Choice B:

Urine output is critical because magnesium is excreted renally. Output <30 mL/hr increases the risk of accumulation and toxicity. Renal impairment or oliguria necessitates dose adjustment or discontinuation.

Choice C:

Blood glucose levels are not affected by magnesium sulfate. Hypoglycemia is not a side effect of magnesium therapy. Glucose monitoring is relevant in gestational diabetes or insulin therapy, not in seizure prophylaxis with magnesium.

Choice D:

Respiratory rate must be monitored because magnesium depresses the respiratory center. A rate <12 breaths/min suggests impending respiratory failure. Continuous pulse oximetry and respiratory assessment are mandatory during infusion.

Choice E:

Fetal heart rate baseline variability is not a direct indicator of maternal magnesium toxicity. While magnesium may cause mild fetal sedation, it does not reliably reflect maternal serum levels or toxicity. Fetal monitoring is important but not a toxicity marker.

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