HESI RN Care of Women and Pediatric Nursing | Nurselytic

Questions 38

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HESI RN Care of Women and Pediatric Nursing Questions

Extract:

History and Physical
Nurses' Notes
Vital Signs
Diagnostic Results
Provider's Prescriptions
The client is gravida 4, term 3, preterm 0, abortions 0, living children 3 (GTPAL), at 37 weeks and 1 day gestation by 10-week ultrasound. She presents with contractions every 3 to 4 minutes for the past 2 hours. The vaginal examination reveals she is 4 cm dilated, 50% effaced, and at -3 station. Membranes are intact. Prenatal course is unremarkable, with normal laboratory results. The estimated fetal weight by Leopold's maneuver is 6 pounds (2.72 kg).


Question 1 of 5

Complete the diagram by selecting: The condition the client is most likely experiencing. Two actions the nurse should take to address the condition. Two parameters the nurse should monitor to assess the client's progress.

OptionsNormalAbnormal
Preeclampsia with severe features.
Gestational hypertension.
Placental abruption.
Preterm labor.
Actions to Take Choices A. Administer magnesium sulfate as prescribed. B. Prepare for emergency cesarean section. C. Place the client in a supine position. D. Monitor for signs of magnesium toxicity. E. Restrict the client’s fluid intake to 500 mL per day.
Parameters to Monitor Choices A. Urine output of at least 30 mL/hour B. Fetal heart rate variability C. Oxygen saturation of at least 95% D. Serum magnesium levels above 8 mg/dL E. Deep tendon reflexes

Correct Answer: A

Rationale: Condition: Preeclampsia with severe features ' due to high blood pressure (170/98 mmHg) and magnesium sulfate use. Actions: Administer magnesium sulfate ' to prevent seizures and monitor for toxicity '. Parameters: Monitor urine output (A, ≥30 mL/hour) for renal function and deep tendon reflexes ' for toxicity. Gestational hypertension ', placental abruption ', and preterm labor ' do not fit the clinical picture.

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Question 2 of 5

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Question 5 of 5

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