A nurse is assessing a client who is at 8 weeks of gestation and has hyperemesis gravidarum.
Which of the following are findings of this condition? (Select all that apply.)

Tachycardia.

Dry mucous membranes.

Poor skin turgor.

Polyuria.

Hypertension.

Answer and Explanation

Correct Answer : A,B,C

Choice A rationale

Tachycardia is a common finding in hyperemesis gravidarum due to fluid volume deficit. Significant and persistent vomiting leads to hypovolemia, which triggers a compensatory increase in heart rate to maintain cardiac output and tissue perfusion. The body attempts to compensate for reduced circulating blood volume by increasing the rate at which blood is pumped.

Choice B rationale

Dry mucous membranes are a direct clinical sign of dehydration, which is a hallmark of hyperemesis gravidarum. Prolonged and severe vomiting leads to significant fluid loss, depleting the body's water content. This desiccation is visibly manifested in the oral cavity as dry and sticky mucous membranes, indicating intracellular and extracellular fluid deficit.

Choice C rationale

Poor skin turgor, characterized by skin that remains tented when pinched, is another objective indicator of dehydration. The loss of interstitial fluid due to excessive vomiting reduces the elasticity and plumpness of the skin. This finding reflects a significant depletion of fluid volume within the subcutaneous tissues.

Choice D rationale

Polyuria, meaning excessive urination, is not a typical finding in hyperemesis gravidarum. Instead, severe vomiting and dehydration would lead to oliguria (decreased urine output) as the kidneys attempt to conserve fluid to compensate for the significant fluid losses. The body's priority is fluid retention.

Choice E rationale

Hypertension is generally not associated with hyperemesis gravidarum. Due to significant fluid loss and dehydration, clients with hyperemesis gravidarum are more likely to experience orthostatic hypotension or even profound hypotension as a result of hypovolemia. The decreased circulating blood volume leads to reduced vascular resistance and blood pressure.

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Correct Answer is B

Explanation

Choice A rationale

Group B Streptococcus (GBS) colonization in a pregnant client does not typically necessitate a cesarean birth. The primary concern with GBS is the risk of vertical transmission to the neonate during vaginal birth, which can lead to severe neonatal infections like sepsis, meningitis, or pneumonia. Cesarean section is generally reserved for obstetric indications and does not eliminate the risk of GBS transmission if membranes rupture.

Choice B rationale

Intravenous antibiotic prophylaxis is the cornerstone of preventing neonatal GBS disease in colonized mothers. The recommended antibiotics, typically penicillin or ampicillin, are administered during labor once ruptured membranes or active labor commence. This intrapartum treatment significantly reduces bacterial colonization in the birth canal, thereby minimizing the neonate's exposure to the bacteria during passage.

Choice C rationale

A vaginal culture for GBS is typically performed between 36 and 37 weeks of gestation as part of routine prenatal screening. If the client has already been screened and identified as GBS positive at 36 weeks, repeating the culture during active labor is not indicated as the colonization status is already known, and the focus shifts to prophylaxis.

Choice D rationale

Metronidazole is an antibiotic primarily effective against anaerobic bacteria and certain parasites. It is not the drug of choice for Group B Streptococcus prophylaxis. Penicillin or ampicillin are the preferred antibiotics for GBS intrapartum prophylaxis due to their effectiveness against GBS and their favorable safety profile for both the mother and the fetus.

A. "It is important to gain 2 pounds per week throughout the rest of your pregnancy.”. B. "You can cause problems for your baby if you try to diet while pregnant.”. C. "It would be helpful for us to meet with the dietitian to see how they can help you meet and assess your nutritional needs.”. D. "You should eat an additional 700 calories per day while you are pregnant.”.

Correct Answer is C

Explanation

Choice A rationale

While weight gain is crucial during pregnancy, a blanket statement of 2 pounds per week is not universally appropriate. The recommended rate of weight gain varies based on the client's pre-pregnancy BMI and the trimester. Excessive or insufficient weight gain can lead to adverse maternal and fetal outcomes, including macrosomia or intrauterine growth restriction, highlighting the need for individualized nutritional guidance rather than a fixed weekly gain.

Choice B rationale

Dieting during pregnancy, especially restrictive calorie intake, can significantly compromise the nutrient supply to the developing fetus. Fetal growth and organogenesis are highly dependent on adequate maternal nutritional stores and daily nutrient intake. Inadequate nutrition can lead to low birth weight, premature birth, and long-term health complications for the infant, emphasizing the dangers of unguided dietary restrictions.

Choice C rationale

A dietitian possesses specialized knowledge in medical nutrition therapy and can provide personalized recommendations based on the adolescent's specific nutritional needs, gestational age, and pre-pregnancy weight. This collaborative approach ensures optimal maternal and fetal health by addressing any deficiencies, managing appropriate weight gain, and promoting healthy eating habits throughout the pregnancy, which is crucial for adolescent development and pregnancy outcomes.

Choice D rationale

The caloric needs of a pregnant adolescent increase in the second and third trimesters, but a fixed additional 700 calories per day may not be accurate for all individuals. Caloric requirements are dynamic and depend on pre-pregnancy weight, activity level, and the specific stage of gestation. Overestimation can lead to excessive weight gain, while underestimation can result in inadequate fetal growth, necessitating individualized assessment.

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A nurse is assessing a client who is at 8 weeks of gestation and has hyperemesis gravidarum. Which of the following are findings of this condition? (Select all that apply.)

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Explanation

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Correct Answer is C

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A nurse is assessing a client who is at 8 weeks of gestation and has hyperemesis gravidarum.
Which of the following are findings of this condition? (Select all that apply.)