HESI Case Studies–Obstetric/Maternity-Preeclampsia (Jennie Smith)
1. In reviewing Jennie’s history, the RN is correct in concluding that Jennie is in jeopardy of developing a hypertensive disorder because of her age (15). Which other factor(s) add to Jennie’s risk of developing preeclampsia? (Select all)
-Preexisting medical or genetic condition, such as Factor V Leiden
2. To accurately assess this client’s condition, what information from the prenatal record is most important for the RN to obtain?
Prenatal blood pressure readings
3. What is the pathophysiology responsible for Jennie’s complaint of a pounding headache and the elevated DTRs?
4. Jennie’s sister is concerned about the edema in her sister’s face and hands. She asks the RN if the (HCP) will prescribe some of “those water pills” (diuretics) to help get rid of the excess fluid. Which response by the RN is correct?
“Let me explain to you about the effect of diuretics on pregnancy.”
5. After the RN establishes IV placement, she collects a bag of D5LR for the oxytocin, which is available as 20 units in 1000mL D5LR. The order from the HCP is oxytocin 2mU/min to augment labor. Calculate the drip rate for the oxytocin. (Whole number)
1/1000 x 2mu/1hr=
0.10 x 60 min=
6. While the RN is awaiting the lab results to determin if Jennie has elevatioin in liver function, diminished kidney function, or altered coagulopathies, which question should the RN ask Jennie? (Select all)
-“Do you have a headache?”
-“Do you have blurry vision?”
-“Do you have epigastric pain?”
-“Do you have shortness of breath or chest discomfort?”
7. Which technique should the RN use when evaluating Jennie’s blood pressure while Jennie is on bedrest?
Have Jennie lie in a lateral position and take the blood pressure on the dependent arm
8. When performing a nonstress test, the RN will be assessing for which parameters?
Acceleration of the fetal heart rate in response to fetal movement
9. If Jennie had HELLP syndrome, which lab results would the RN expect to see?
Decreased hemoglobin and hematocrit with burr cells, elevated liver enzymes, platelet count 3
10. The day shift charge nurse is preparing to make client care assignments. Which client should be assigned to the most experienced RN?
A 35-year-old gravida 3, para 2, with HELLP syndrome
11. What is the primary action of magnesium sulfate when given in preeclampsia?
A CNS depressant
12. Since Jennie is receiving magnesium sulfate and oxytocin, the RN should make what adjustments to the oxytocin?
No adjustment to the oxytocin induction
13. Which assessment finding would indicate to the RN that a client is experiencing magnesium sulfate toxicity?
Respiratory rate of <12 breaths/min, and absent DTRs
14. The RN asks Jennie if the HCP has discussed the labor and delivery process, potential complications, and the management of those complications with her and if she understands them. Jennie replies “I think so,” and then asks for a pen. Which action should the RN take?
Ask Jennie to explain what she understands about the procedures
15. Jennie’s sister offers to sign the consent forms for her because Jennie is so young and just isn’t feeling well right now. Which response by the RN is correct?
“Jennie should sign the consent forms herself since she is the one receiving the care.”
16. Jennie asks why the magnesium sulfate was increased. What explanation should the RN provide?
The magnesium is being excreted through the kidneys
17. When the RN evaluates the fetal monitor strip, she notes a decrease in the fetal heart rate with minimal variability. What is the best explanation for this change?
The fetus has a magnesium level equal to the mother’s, causing the fetus to be somewhat sedated
18. At 0930 Jennie’s sister rings the call bell and yells, “Come quickly, Jennie is shaking all over.” The RN determines that Jennie is experiencing an eclamptic seizure. Which nursing intervention takes priority?
Turn Jennie onto her side and place a pillow behind her to stabilize the position
19. The RN recognizes what type of periodic fetal heart rate change that is occurring?
20. What should the RN do next to ensure intrauterine resuscitation?
Implement a prescribed fluid bolus to improve maternal blood volume
21. What medication should the RN have readily available as an antidote for magnesium sulfate?
22. For which complication is Jennie most at risk following the epidural with a local anesthestic, such as bupivacaine or ropivacaine?
23. At 1130 Jennie complains of rectal pressure and an urge to push. The RN reviews the proper pushing technique with Jennie and her partner. What should the RN tell Jennie?
When the urge to push is felt, take a deep breath and bear down while exhaling over 5 to 7 seconds. Then take another deep breath and repeat the pushing pattern until the urge to push subsides.
24. The NICU RN anticipates and prepares for which complications in the newborn related to treatment of the mother with magnesium sulfate?
Hyporeflexia and decreased respirations
25. Jennie remains on magnesium sulfate. No further seizures have occurred, and she is stable at the present time. The anesthesia provider has released Jennie from the postanesthesia care unit. Which room and nursing staff assignments should be made for Jennie?
Move Jennie to a quiet room close to the nursing station in Labor and Delivery, and assign one RN to care for her
26. Jennie’s partner asks if some friends can come and watch television with him now that the baby has been born. Which response by the RN is most appropriate?
“Your partner is still at risk for complications, so visitors are limited to family members, and only for a short period of time.”
27. The RN is aware that which medication is safest for Jennie if a second drug is needed to treat postpartum hemorrhage?