A 31 weeks pregnant mother, came to antenatal clinic and she not have any previous epilepsy history, but present time BP 150/110 pulse 100, 3+ grade proteinuria. On duty nurse know that which medicine will prescribed by a doctor?

1. A

   Magnesium sulphate

2. B

   Labetalol

3. C

   Calcium gluconate

4. D

   Hydralazine

Appeared in: PGIMER NO - 2020

Explanation

• The patient's signs and symptoms (BP 150/110 mmHg, 3+ proteinuria at 31 weeks) are diagnostic of severe pre-eclampsia.
• Magnesium sulphate is the first-line medication and gold standard for the prophylaxis (prevention) of eclamptic seizures in patients with severe pre-eclampsia.
• Its primary action is as a central nervous system depressant, which raises the seizure threshold and prevents the progression from severe pre-eclampsia to eclampsia (seizures).
• While controlling blood pressure is important, preventing life-threatening seizures is the immediate priority in this clinical scenario.

Why Other Options Were Wrong

• Option A: Labetalol is an antihypertensive drug used to lower blood pressure. While it is used in severe pre-eclampsia, its purpose is to prevent stroke, not seizures. Seizure prophylaxis with Magnesium sulphate is the primary intervention.
• Option C: Calcium gluconate is the antidote for Magnesium sulphate toxicity. It is not used to treat pre-eclampsia itself.
• Option D: Hydralazine, like Labetalol, is an antihypertensive medication. It is used for the acute management of severe hypertension in pregnancy but does not have the anticonvulsant properties of Magnesium sulphate.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Pharmacological management of severe pre-eclampsia helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• A nurse must be able to rapidly identify the signs of severe pre-eclampsia and anticipate the immediate need for Magnesium sulphate to prevent life-threatening eclamptic seizures.
• Vigilant nursing assessment for signs of magnesium toxicity (loss of reflexes, respiratory depression, decreased urine output) is a critical patient safety responsibility during infusion. The antidote, calcium gluconate, must always be available at the bedside.
• What if? If the patient's blood pressure was 170/115 mmHg, the nurse would anticipate orders for BOTH Magnesium sulphate (for seizure prophylaxis) and an antihypertensive like Labetalol or Hydralazine (to prevent stroke).

How to Approach the Question

• First, analyze the patient's clinical data: 31 weeks pregnant, BP 150/110 mmHg, 3+ proteinuria.
• Recognize that this combination of findings after 20 weeks of gestation is the classic presentation of severe pre-eclampsia.
• Recall the primary, life-threatening complication of severe pre-eclampsia, which is the progression to eclampsia (seizures).
• Identify the drug of choice for seizure prophylaxis in this condition.
• Evaluate the options: Labetalol and Hydralazine are antihypertensives, Calcium gluconate is an antidote, and Magnesium sulphate is the anticonvulsant used for seizure prevention.
• Conclude that the most anticipated and critical medication to be prescribed is Magnesium sulphate.

Concept Tested & Keywords

• Concept Tested: Pharmacological management of severe pre-eclampsia
• Stem keywords: 31 weeks pregnant, no previous epilepsy history, BP 150/110, 3+ grade proteinuria
• Lead-in keywords: which medicine will prescribed
• Clinical cues: The combination of hypertension (150/110 mmHg) and significant proteinuria (3+) in a pregnant woman beyond 20 weeks gestation is a classic presentation of severe pre-eclampsia.
• Clinical cues: The absence of a previous epilepsy history points towards the seizures being a complication of the pregnancy (eclampsia), not a pre-existing condition.

Question ID

QVQ3WIRWTe8ZZKjjun9wyZ

Copy ID

Reference Book

E6 Obstetrics Williams p. 33-53