The mother's blood pressure climbs to 170/100 mmHg. Which of the following symptoms would suggest to the nurse that the patient may be about to convulse?

1. A

   Increased fetal movements

2. B

   Decreased temperature

3. C

   Epigastric pain

4. D

   Urine Output of 40 ml/hour

Appeared in: BCCL kharkhanda Staff Nurse - 2015

Explanation

• Epigastric pain in a patient with severe preeclampsia is an ominous symptom indicating liver involvement.
• The pain is caused by stretching of the liver capsule (Glisson's capsule) due to hepatic edema and hepatocellular necrosis.
• This sign suggests the disease is progressing and that a convulsion (eclampsia) may be imminent.
• It is considered a criterion for diagnosing preeclampsia with severe features, even in the absence of significant proteinuria.

Why Other Options Were Wrong

• Option A: Increased fetal movements are not a recognized sign of impending eclampsia. Fetal well-being is often compromised in severe preeclampsia, which typically leads to decreased, not increased, fetal movement.
• Option B: A decreased body temperature is not associated with the pathophysiology of preeclampsia or eclampsia. In fact, fever can sometimes occur following a seizure.
• Option D: A urine output of 40 ml/hour is within the normal, adequate range for an adult (greater than 30 ml/hour).

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Identification of warning signs for impending eclampsia in a patient with severe preeclampsia to guide bedside assessment, documentation, and the next nursing action.
• A nurse must recognize that epigastric pain in a hypertensive pregnant patient is a medical emergency.
• Immediate nursing actions include notifying the healthcare provider, initiating seizure precautions (e.g., padded side rails, dimming lights, ensuring suction and oxygen are available), and preparing for the administration of magnesium sulfate as ordered.
• Failure to recognize and act on this symptom can lead to maternal seizure, stroke, liver rupture, and death.

How to Approach the Question

• First, identify the key information in the clinical scenario: a pregnant patient with a very high blood pressure (170/100 mmHg). This immediately signals severe preeclampsia.
• Next, understand the question: it asks for a symptom that suggests an impending convulsion (eclampsia). This requires knowledge of the 'danger signs' or 'ominous symptoms' of severe preeclampsia.
• Evaluate each option based on the pathophysiology of preeclampsia.
• Option A (Increased fetal movements): Recall that placental insufficiency in preeclampsia is more likely to cause fetal distress and decreased movement.
• Option B (Decreased temperature): This is not a known symptom of preeclampsia.
• Option C (Epigastric pain): Recognize this as a classic sign of liver involvement (swelling and ischemia), which is a severe feature indicating the disease is worsening and a seizure is possible.

Concept Tested & Keywords

• Concept Tested: Identification of warning signs for impending eclampsia in a patient with severe preeclampsia.
• Stem keywords: blood pressure 170/100 mmHg, pregnant, convulse
• Lead-in keywords: symptoms would suggest
• Clinical cues: A blood pressure of 170/100 mmHg indicates severe hypertension in pregnancy, placing the patient at high risk for eclampsia.

Question ID

QJFgptaVJm1YQRryuDjqgG

Copy ID

Reference Book

E6 Obstetrics Williams p. 2-9

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 34-42