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Nursing QUESTION #9124
Question 1
A primigravida at 38 weeks gestation presents with BP 158/106 mmHg, proteinuria 3+, severe headache, and epigastric pain. Which immediate management is MOST appropriate?
  • Administer oral antihypertensive and discharge
  • Administer IV Magnesium Sulfate loading dose 4g over 15–20 min and prepare for delivery✔️
  • Perform emergency cesarean section immediately without any pharmacotherapy
  • Administer oral nifedipine 10 mg and observe for 2 hours
Correct Answer Explanation

This clinical picture is classic Severe Preeclampsia with impending eclampsia (headache + epigastric pain = HELLP syndrome risk). The cornerstone of management is:

  • IV Magnesium Sulfate (MgSO₄): Loading dose = \(4\,\text{g}\) in 20 mL normal saline IV over 15–20 minutes, followed by maintenance \(1{-}2\,\text{g/hr}\).
  • It prevents seizures (eclampsia) by acting as a CNS depressant and cerebral vasodilator.
  • After stabilization, delivery (induction or cesarean) is planned based on cervical readiness.
  • Oral antihypertensives alone are insufficient in an emergency setting with severe features.
  • Immediate CS without seizure prophylaxis increases maternal risk.

Always remember: MgSO₄ first, then delivery in severe preeclampsia with severe features.