A 33-week pregnant client presents with severe right upper quadrant pain, nausea, and malaise. The provider suspects HELLP syndrome. Which combination of laboratory findings would confirm the diagnosis? (Select All that Apply.)

Hemolysis

Elevated liver enzymes

Severe hypertension

Hyperglycemia

Low platelets

Answer and Explanation

Correct Answer : A,B,E

A. Hemolysis occurs due to microvascular endothelial damage, which leads to fragmentation and destruction of red blood cells. Laboratory evidence includes elevated lactate dehydrogenase (LDH >600 U/L), elevated indirect bilirubin, and decreased haptoglobin. This contributes to fatigue, malaise, and jaundice in severe cases.

B. Elevated liver enzymes indicate hepatocellular injury caused by microvascular damage. Laboratory evidence includes AST >70 U/L and mildly to moderately elevated ALT. This liver damage correlates with right upper quadrant or epigastric pain and may also lead to nausea and vomiting.

C. Although often present, severe hypertension is not required for diagnosis. Some women with HELLP may have only mild or normal blood pressure, so elevated blood pressure alone cannot confirm the syndrome.

D. Hyperglycemia is unrelated; blood glucose levels are usually normal in HELLP syndrome. Elevated glucose may suggest another metabolic disorder such as gestational diabetes.

E. Low platelets occur due to platelet aggregation and consumption in the damaged microvasculature. Laboratory evidence includes platelet counts <100,000/mm³. This increases the risk for bleeding, bruising, and complications during delivery.

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Correct Answer is C

Explanation

A. Referred pain occurs when pain is perceived in an area different from the site of the actual tissue damage (e.g., shoulder pain from gallbladder disease). In this scenario, the pain is localized to the joints, not referred, so this is incorrect.

B. Procedural pain is short-term pain associated with medical procedures such as injections, IV insertions, or surgeries. Persistent joint pain lasting 4 months is not related to a procedure, so this is incorrect.

C. Chronic pain is defined as pain that persists longer than 3 months or beyond the expected period of healing. This 13-year-old has had joint pain for 4 months, meeting the criteria for chronic pain. Chronic pain in juvenile arthritis can affect physical activity, school performance, and psychosocial well-being, and requires long-term management strategies.

D. Acute pain is short-term, sudden in onset, and usually associated with tissue injury or inflammation, typically resolving within days to weeks. Pain lasting 4 months exceeds the acute timeframe, so this is incorrect.

A. Abdominal pain with scan red vaginal bleeding B. Painless red vaginal bleeding C. Increasing abdominal pain with a rigid abdomen D. Intermittent abdominal pain following passage of bloody mucus

Correct Answer is B

Explanation

A. Placenta previa typically presents with painless bleeding, not pain. Abdominal pain with bleeding is more suggestive of placental abruption, not previa.

B. Placenta previa is characterized by bright red, painless vaginal bleeding during the second or third trimester, often without uterine tenderness or contractions. The bleeding occurs because the placenta implants over or near the cervical os, which disrupts vascular integrity as the cervix begins to efface or dilate.

C. This presentation is more consistent with abruptio placentae, where the placenta separates prematurely, leading to painful bleeding and a firm, tender uterus.

D. This describes bloody show, which is a sign of labor onset, not placenta previa. It is associated with cervical effacement and dilation rather than abnormal placental implantation.

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A 33-week pregnant client presents with severe right upper quadrant pain, nausea, and malaise. The provider suspects HELLP syndrome. Which combination of laboratory findings would confirm the diagnosis? (Select All that Apply.)

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Naxlex Comprehensive Predictor Exams

A 13-year-old with juvenile arthritis has been experiencing persistent joint pain for the past 4 months. Which statement BEST defines this type of pain?

Correct Answer is C

Explanation

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Correct Answer is B

Explanation

A 33-week pregnant client presents with severe right upper quadrant pain, nausea, and malaise. The provider suspects HELLP syndrome. Which combination of laboratory findings would confirm the diagnosis? (Select All that Apply.)

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