A woman at 34 weeks of gestation is brought to the hospital after experiencing a tonic-clonic seizure. Her blood pressure is 160/110 mmHg, and urinalysis reveals 3+ proteinuria. Which diagnosis and corresponding priority management plan is most appropriate?

Appeared in: NORCET 9 Prelims-2025

Explanation

The patient's presentation of a tonic-clonic seizure combined with severe hypertension (160/110 mmHg) and significant proteinuria (3+) is the classic triad for eclampsia.
Eclampsia is a life-threatening obstetric emergency where pre-eclampsia progresses to cause generalized seizures.
The immediate priority is to stabilize the mother by controlling the seizure and preventing recurrence. Intravenous (IV) magnesium sulfate is the drug of choice for seizure prophylaxis and treatment.
Following maternal stabilization, the definitive treatment for eclampsia is the delivery of the fetus and placenta. At 34 weeks' gestation, this is urgently indicated to resolve the condition and prevent further harm to the mother and baby.

Option A: While the patient does have severe pre-eclampsia, the occurrence of a seizure progresses the diagnosis to eclampsia. The management described is incomplete as it omits the critical step of seizure control with magnesium sulfate.
Option C: HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a laboratory diagnosis and a severe variant of pre-eclampsia. Although it can coexist with eclampsia, the primary diagnosis guiding immediate emergency action is eclampsia due to the active seizure.
Option D: Gestational hypertension is defined as elevated blood pressure after 20 weeks of gestation without proteinuria or other signs of pre-eclampsia. This patient's significant proteinuria and seizure definitively rule out this diagnosis.

Visual 1: Flowchart: Differentiating Hypertensive Disorders in Pregnancy. This visual would help learners distinguish between gestational hypertension, pre-eclampsia, eclampsia, and HELLP syndrome based on key signs and symptoms.
Visual 2: Infographic: Emergency Management of an Eclamptic Seizure. This would outline the step-by-step nursing actions, including patient positioning, airway management, and administration of magnesium sulfate.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Diagnosis and Priority Management of Eclampsia in acute care settings.
Nurses must recognize eclampsia as a critical obstetric emergency. The priority is always maternal safety: maintain a patent airway, ensure patient safety during the seizure (e.g., side-lying position, padded side rails), and administer magnesium sulfate as ordered.
Continuous monitoring for signs of magnesium toxicity is a crucial nursing responsibility. This includes assessing for loss of deep tendon reflexes (patellar reflex), respiratory depression (rate less than 12/min), and decreased urine output (less than 30 mL/hr). Calcium gluconate should be readily available as an antidote.
What if? If the patient presented with the same blood pressure and proteinuria but without a seizure, the diagnosis would be severe pre-eclampsia. Management would focus on blood pressure control and close maternal-fetal monitoring, with a plan for delivery, but it would not be the same level of immediate emergency as an active seizure.

How to Approach the Question

First, analyze the clinical data provided in the stem: a pregnant patient at 34 weeks, a tonic-clonic seizure, a blood pressure of 160/110 mmHg, and 3+ proteinuria.
Identify the most critical finding, which is the tonic-clonic seizure. A seizure in a pregnant woman with signs of hypertension and proteinuria is the hallmark of a specific, severe condition.
Recall the definitions of hypertensive disorders in pregnancy. The combination of pre-eclampsia (hypertension and proteinuria) with a seizure defines eclampsia.
Systematically evaluate the options. Eliminate 'Severe pre-eclampsia' because the seizure has occurred. Eliminate 'Gestational hypertension' because there is significant proteinuria. Eliminate 'HELLP syndrome' as it's a lab diagnosis and the seizure is the defining clinical event for eclampsia.
Assess the management plan for eclampsia. The standard of care prioritizes seizure control with IV magnesium sulfate, followed by antihypertensives and preparation for delivery.
Select the option that correctly pairs the diagnosis (Eclampsia) with the appropriate priority management (stabilize with IV magnesium sulfate and prepare for imminent delivery).

Concept Tested & Keywords

Concept Tested: Diagnosis and Priority Management of Eclampsia
Stem keywords: 34 weeks of gestation, tonic-clonic seizure, blood pressure 160/110 mmHg, 3+ proteinuria
Lead-in keywords: most appropriate, priority management
Clinical cues: The presence of a seizure is the key differentiator that elevates the diagnosis from severe pre-eclampsia to eclampsia, which is a life-threatening emergency.
Negative lead-in flag: false

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Practise the full NORCET 9 Prelims-2025

Attempt every question from this paper in a timed mock, then review the full solution for each one.