Practice Mode – Questions and choices are randomly arranged, the answer is revealed instantly after each question, and there is no time limit for the exam.
Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.
Text Mode – Text version of the exam
1. A pregnant client is receiving magnesium sulfate therapy for the control of preeclampsia. A nurse discover that the client is encountering toxicity from the medication in which of the following assessment?
- Urine output of 25 ml/hr.
- The presence of deep tendon reflex.
- Respirations of 10 breaths per minute.
- Serum magnesium level of 7 mEq/L.
2.Which of the following conditions is associated with elevated serum chloride levels?
3. Methergine or pitocin are prescribed for a client with PP hemorrhage. Before administering the medication(s), the nurse contacts the health provider who prescribed the medication(s) in which of the following conditions is documented in the client’s medical history?
- Peripheral vascular disease
- Type 1 diabetes
4.A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for:
- Any bleeding, such as in the gums, petechiae, and purpura.
- Enlargement of the breasts
- Periods of fetal movement followed by quiet periods
- Complaints of feeling hot when the room is cool
5. A homecare nurse visits a pregnant client who has a diagnosis of mild Preeclampsia and who is being monitored for pregnancy induced hypertension (PIH). Which assessment finding indicates a worsening of the Preeclampsia and the need to notify the physician?
- Blood pressure reading is at the prenatal baseline
- Urinary output has increased
- The client complains of a headache and blurred vision
- Dependent edema has resolved
6. A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse’s first action is to:
- Administer magnesium sulfate intravenously
- Assess the blood pressure and fetal heart rate
- Clean and maintain an open airway
- Administer oxygen by face mask
7. A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)?
- Elevated blood pressure
- Negative urinary protein
- Facial edema
- Increased respirations
8. A pregnant client is receiving magnesium sulfate for the management of preeclampsia. A nurse determines the client is experiencing toxicity from the medication if which of the following is noted on assessment?
- Presence of deep tendon reflexes
- Serum magnesium level of 6 mEq/L
- Proteinuria of +3
- Respirations of 10 per minute
9. A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if:
- Ankle clonus in noted
- The blood pressure decreases
- Seizures do not occur
- Scotomas are present
10. A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client.
- Monitor maternal vital signs every 2 hours
- Notify the physician if respirations are less than 18 per minute.
- Monitor renal function and cardiac function closely
- Keep calcium gluconate on hand in case of a magnesium sulfate overdose
- Monitor deep tendon reflexes hourly
- Monitor I and O’s hourly
- Notify the physician if urinary output is less than 30 ml per hour.
Answers & Rationales
1.Answer: C. Respirations of 10 breaths per minute. Magnesium sulfate is a central nervous system depressant and anticonvulsant. It can cause smooth muscle relaxation. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, decreased urine output, loss of deep tendon reflexes, hypotension and a decrease maternal and fetal heart rate.
- Option A: Urine output should be maintained at 25-30ml/hr.
- Option B: Deep tendon reflexes must be present.
- Option D: Normal range for magnesium is between 4-7 mEq/L
2.Answer: C. eclampsia. Eclampsia is associated with increased levels of serum chloride.
3.Answer: A. Peripheral vascular disease. These medications are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstriction effects of these medications.
4.Answer: A. Any bleeding, such as in the gums, petechiae, and purpura. Severe Preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D.
5. Answer: C. The client complains of a headache and blurred vision. If the client complains of a headache and blurred vision, the physician should be notified because these are signs of worsening Preeclampsia.
6.Answer: C. Clean and maintain an open airway. The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased.
7.Answers: A Elevated blood pressure and 3 Facial edema. The three classic signs of preeclampsia are hypertension, generalized edema, and proteinuria. Increased respirations are not a sign of preeclampsia.
8. Answer: D. Respirations of 10 per minute. Magnesium toxicity can occur from magnesium sulfate therapy. Signs of toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden drop in the fetal heart rate and maternal heart rate and blood pressure. Therapeutic levels of magnesium are 4-7 mEq/L. Proteinuria of +3 would be noted in a client with preeclampsia.
9.Answer: C. Seizures do not occur. For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.
10. Answers: C, D, E, F, and G. When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.