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VSIM - OLIVIA JONES QUESTIONS
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VSIM - OLIVIA JONES QUESTIONS
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VSIM - OLIVIA JONES QUESTIONSWhich of the entries on a patient's medical record are evidence of the diagnosis of
severe preeclampsia? (Select all that apply.)
a) Oliguria
b) Blood pressure 182/116 mmHg
c) 3 lb (1.4 kg) weight gain in 1 week
d) Epigastric pain
e) Negative urine ketones
f) Scotomata - Answers -a) Oliguria
b) Blood pressure 182/116 mmHg
c) 3 lb (1.4 kg) weight gain in 1 week
d) Epigastric pain
f) Scotomata
All of these findings, except negative ketones, support the diagnosis. The urine finding
supportive of this diagnosis is the presence of protein.
To assess for clonus, the nurse briskly dorsiflexes the patient's foot and then releases it.
What would a positive response look like?
a) Jerky, rapid contraction of the ankle and foot
b) Foot passively drops to an extended position
c) Smooth rebound of the foot upon release
d) Lack of contraction of the ankle or calf muscle - Answers -a) Jerky, rapid contraction
of the ankle and foot
A positive finding is the rapid, jerky contraction of the ankle and foot in response to the
dorsiflexion performed by the nurse.
What is the therapeutic blood level for a patient receiving an IV infusion of magnesium
sulfate?
a) 10 to 15 mEq/L
b) Over 15 mEq/L
c) 8 to 10 mEq/L
d) 4 to 7 mEq/L - Answers -d) 4 to 7 mEq/L
A therapeutic level is between 4 and 7 mEq/L. Levels of 8 mEq/L or greater are toxic
and the patient will begin to demonstrate symptoms of CNS depression.
A patient with preeclampsia is admitted with vital signs as follows: Temperature 98.6 F
(37 C), heart rate 110 beats per minute (bpm), respiratory rate 28 breaths per minute,
blood pressure 182/116 mmHg, Sp)2 92%. The fetal heart rate (FHR) is 150 bpm.
, Which of the following interventions would the nurse implement based on these
findings?
a) Get an order for an antipyretic
b) Administer oxygen
c) Increase the IV fluid rate
d) Stimulate the fetus - Answers -b) Administer oxygen
The patient is tachypnic and the SpO2 is low. She needs oxygen to meet the needs of
her system and to adequately perfuse oxygenated blood to the uteroplacental unit. An
antipyretic is not needed, as the patient is afebrile. Additional IV fluids would increase
payload and increase blood pressure. The FHR is at the low end of normal, but the
cause of any impending fetal distress is the mother's poor oxygenation status; therefore,
stimulating the fetus is not an effective intervention.
The nurse knows to implement seizure precautions for Ms. Jones because of her
severe preeclampsia. Which of the following actions would the nurse take?
a) Pad the side rails
b) Insert a tongue depressor into the patient's mouth
c) Place the patient's arms and legs in restraints
d) Bring suction equipment to the bedside
e) Have oxygen available - Answers -a) Pad the side rails
d) Bring suction equipment to the bedside
e) Have oxygen available
The side rails are padded for safety. Oxygen and suction equipment are at the bedside
to support the patient and to remove excessive secretions and prevent aspiration, if
needed. Restraints and inserting a tongue depressor may cause injury to the seizing
patient.
Monitoring Ms. Jones's liver enzymes, chemistry panel, and coagulation studies will
assist the nurse to determine if the patient's condition is progressing to what?
a) Adult respiratory distress syndrome
b) Disseminated intravascular coagulation (DIC)
c) Eclampsia
d) HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome - Answers -
d) HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome
Changes in these laboratory parameters will indicate that the patient's severe
preeclampsia is progressing to HELLP syndrome. Changes in coagulation studies
would indicate DIC. Adult respiratory distress syndrome is determined by the
presentation of pulmonary signs and symptoms and changes in arterial blood gases.
Eclampsia is diagnosed by the onset of seizure activity.
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