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At 0600, Ashley is brought to the Labor and Delivery triage area by her sister. The client complains of a pounding headache for the last 12 hours unrelieved by acetaminophen, swollen hands and face for 2 days, blurry vision, and epigastric pain described as bad heartburn. Her sister tells the regis...

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  • January 27, 2025
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  • 2024/2025
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  • at 0600 ashley is brought to the labor and delive

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Preeclampsia - HESI Case Study - NRSG376 || with
Errorless Solutions 100%.
At 0600, Ashley is brought to the Labor and Delivery triage area by her sister. The client
complains of a pounding headache for the last 12 hours unrelieved by acetaminophen, swollen
hands and face for 2 days, blurry vision, and epigastric pain described as bad heartburn. Her
sister tells the registered nurse, "I felt like that when I had toxemia during my pregnancy."

Admission assessment by the nurse reveals the following: today's weight 182 pounds, T 99.1-
degrees F, P 76 beats/minute, R 22 breaths/minute, BP 138/88 mmHg, 4+ pitting edema, and 3+
proteinuria. Heart rate is regular, and lung sounds are clear. Deep tendon reflexes (DTRs) are 3+
biceps and triceps and 4+ patellar with 1 beat of ankle clonus.

The nurse applies the external fetal monitor, which shows a baseline fetal heart rate of 130,
short-term variability present, positive for accelerations, no decelerations, and no contractions.
The nurse also perf correct answers -Familial history
-Preexisting medical or genetic condition, such as Factor V Leiden
-Nulliparity

To accurately assess this client's condition, what information from the prenatal record is most
important for the nurse to obtain?
a) Pattern and number of prenatal visits
b) Prenatal blood pressure readings
c) Pre-preganncy weight
d) Ashely's Rh factor correct answers Prenatal blood pressure readings

Normal pregnancy is a vasodilated state. Peripheral vascular resistance decreased by 25%.
Diastolic BP drops 10 mmHg at mild pregnancy and returns to pre-pregnancy levels at term.
There is a 50% rise in blood volume and cardiac output increases 30% and 50%. Increased renal
flow results in increased glomerular filtration rate. In preeclampsia, the main pathology is poor
organ perfusion as a result of arteriolar vasospasm and endothelial activation. There is an
increase in peripheral resistance when the blood pressure rises. It is more than just hypertension.
It is a systemic disorder. Function in the placenta, liver, brain, and kidneys can be depressed as
much as 40% to 60%. As fluid shifts out of the intravascular compartment, a decrease in plasma
volume and subsequent increase in hematocrit is seen. The edema of preeclampsia is generalized.
This disease affects virtually all organ systems, and the mother and fetus s correct answers
Cerebral edema

Ashely's sister is very concerned about the swelling (edema) in her sister's face and hands
because it seems to be worsening rapidly. She asks the nurse if the healthcare provider (HCP)
will prescribe some of water pills (diuretics) to help get rid of the excess fluid.

Which response by the nurse is correct?
a) "That is a very good idea. I will relay it to the healthcare provider when I call."
b) "I'm sorry, but it is not the family's place to make suggestions about medical treatment."

, c) "Let me explain to you about the effect of diuretics on pregnancy."
d) "Have you by any chance given your sister water pills that belong to someone else?" correct
answers "Let me explain to you about the effect of diuretics on pregnancy."

At 0630, the nurse calls to report to the HCP, who prescribes the following: admit to labor and
delivery, bed rest with bathroom privileges, IV D5LR at 125 mL/hr, oxytocin 2 mu/min, CBC
with platelets, clotting studies, liver enzymes, chemistry panel, 24-hour urine collection for
protein and uric acid, ice chips only by mouth, nonstress test, hourly vital signs, and DTRs.

After the nurse establishes IV placement, she collects a bag of D5LR for the oxytocin, which is
available as 20 units in 1000 mL D5LR. The prescription from the HCP is oxytocin 2 mU/min to
augment labor. What is the drip rate for the oxytocin. (Enter the numerical value only. If
rounding is required, round to the whole number). correct answers 6

20 units = 20,000 mu
(Calculate ml/hour, not drops/min)

While the nurse is awaiting the lab results to determine if Ashley has elevations in liver function,
diminished kidney function, or altered coagulopathies, which question should the nurse ask
Ashely? (Select all that apply).
a) "Do you have any dizziness?"
b) "Do you have blurry vision?"
c) "Do you have abdominal pain?"
d) "Do you have cramping in your calf when you flex your leg?"
e) "Do you have shortness of breath or chest discomfort?" correct answers -"Do you have any
dizziness?"
-"Do you have blurry vision?"
-"Do you have abdominal pain?"
-"Do you have shortness of breath or chest discomfort?"

Which technique should the nurse use when evaluating Ashley's blood pressure while Ashley is
on bedrest?
a) Have Ashely lie supine and take the blood pressure on the left arm
b) Have Ashely lie in a lateral position and take the blood pressure on the dependent arm
c) Have the client sit in a chair at the bedside, and take the blood pressure with her left arm at
waist level
d) Have Ashley stand briefly and take the blood pressure on the right arm correct answers Have
Ashely lie in a lateral position and take the blood pressure on the dependent arm

The nurse performs a nonstress test to evaluate fetal well-being. Ashely is getting nervous and
anxious with the situation. She asks the nurse why she is doing a nonstress test. What is the
nurse's best response?
a) It evaluates the heart rate of the fetus in response to its own movements
b) It measures the oxygen levels of the fetus
c) Accelerations of the fetal heart rate in response to uterine contractions

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