A nurse is caring for a 28-year-old female client at approximately 10 weeks gestation presenting to the antepartum clinic.

Exhibits
Based on these findings, which laboratory value should the nurse review?

Vaginal secretions culture

Glucose in the urine

Hematocrit

Human chorionic gonadotropin (hCG) values

Answer and Explanation

The Correct Answer is D

Choice A rationale: Culturing vaginal secretions is primarily used for identifying infections like bacterial vaginosis or sexually transmitted infections, which are not consistent with the clinical presentation here. The brownish discharge is more likely due to necrotic tissue from proliferative trophoblastic growth than an infectious process. In gestational trophoblastic disease, vaginal bleeding results from abnormal trophoblast invasion and degeneration rather than microbial activity, thus making cultures less diagnostically relevant in this context.

Choice B rationale: While glucose in the urine can signal gestational diabetes, this patient’s presentation is not consistent with hyperglycemia-related symptoms such as polyuria or excessive thirst. Gestational trophoblastic disease is characterized by exaggerated pregnancy symptoms, including hyperemesis gravidarum due to elevated hCG levels, not insulin resistance. The greatly enlarged uterus and lack of fetal heart tones suggest molar pregnancy rather than a metabolic disturbance, making this lab test low priority for confirming diagnosis.

Choice C rationale: Hematocrit values help assess anemia or hemoconcentration but are non-specific in the diagnosis of gestational trophoblastic disease. While bleeding may affect hematocrit, the mild nature of the bleeding here does not support significant blood loss. Additionally, hematocrit changes lag behind acute events and do not correlate well with uterine size or nausea severity. The hypertensive reading suggests trophoblastic proliferation stimulating preeclampsia-like symptoms, which cannot be clarified through hematocrit alone.

Choice D rationale: Human chorionic gonadotropin (hCG) levels are crucial for confirming gestational trophoblastic disease, as they are markedly elevated due to hyperproliferation of trophoblastic cells. Normal hCG levels at 10 weeks range between 44,000–210,000 mIU/mL. In hydatidiform mole, levels often exceed these thresholds dramatically. hCG drives trophoblast proliferation and correlates with uterine size and severity of symptoms like nausea. This value helps differentiate between viable pregnancy and molar or neoplastic gestation

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Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

Rationale for correct answers

The client exhibits classic signs of postpartum hemorrhage (PPH): excessive vaginal bleeding (saturating a pad every 1–1.5 hours), presence of large clots, a boggy uterus, and dizziness. Her hemoglobin decreased from 10.4 g/dL to 9 g/dLand hematocrit from 32% to 28%, both below normal postpartum reference values (>11 g/dL and >33%, respectively), indicating significant blood loss. The boggy uterine tone and hyperechoic intrauterine contents support retained placental tissue, which impedes uterine contraction and prolongs bleeding. Following tissue expulsion, her uterus became firm and lochia decreased—confirming the cause.

Rationale for incorrect Response 1 options

Postpartum infection:Despite a brief low-grade fever, there are no signs of uterine tenderness post-expression, nor foul-smelling lochia or systemic infection markers.
Uterine rupture:This presents with severe abdominal pain, cessation of contractions, and fetal compromise. No such indicators exist; delivery was completed 14 hours ago.
Preeclampsia:Typically involves hypertension >140/90 mm Hg and proteinuria. The client’s BP is elevated but lacks diagnostic criteria, and no neurological or renal signs are present.

Rationale for incorrect Response 2 options

Prolonged labor/vacuum delivery:These are risk factors for hemorrhage but not direct causes. They contribute indirectly via trauma or uterine fatigue.
Breastfeeding-induced contractions:Normally enhance uterine involution, not cause hemorrhage.
Lacerations:Though present, they are intact without signs of active bleeding or hematoma formation.

Take-home points

Retained placental tissue is a leading cause of late or unresponsive postpartum hemorrhage.
Differentiate PPH from infection via uterine tone, lochia characteristics, and systemic signs.
Hyperechoic endometrial patterns on ultrasound may suggest retained products.
Monitor hematologic values in postpartum clients for evolving hemorrhage.

A. The client is experiencing an allergic reaction; the nurse should administer epinephrine immediately. B. The client has developed a urinary tract infection; the nurse should collect a urine sample for culture and sensitivity. C. The client is presenting with signs of preeclampsia; the nurse should monitor for seizure activity and administer prescribed medications. D. The client is experiencing a hypertensive crisis; the nurse should prepare for immediate surgery.

Correct Answer is C

Explanation

Choice A rationale

The client's symptoms, including severe headache, nausea, right-sided upper abdominal pain, and hyperreflexia (4+ DTRs), are classic indicators of severe preeclampsia, not an allergic reaction. An allergic reaction typically involves hives, itching, and respiratory distress. Administering epinephrine is an inappropriate intervention and would likely worsen the client's condition.

Choice B rationale

A urinary tract infection (UTI) typically presents with symptoms such as dysuria, frequency, and suprapubic pain. While a headache and nausea can be systemic symptoms of an infection, they do not explain the hyperreflexia or the right-sided upper abdominal pain. A UTI is a less likely diagnosis given the constellation of symptoms.

Choice C rationale

The symptoms presented, including a severe headache, nausea, right-sided upper abdominal pain (suggesting liver involvement), and hyperreflexia, are the hallmarks of severe preeclampsia. The priority intervention is to monitor for seizure activity and administer prescribed medications, such as magnesium sulfate, to prevent the progression to eclampsia, which is a life-threatening complication.

Choice D rationale

While the client is experiencing hypertension, the constellation of symptoms points to preeclampsia, a specific condition, rather than a general hypertensive crisis. Immediate surgery is not the first intervention. The priority is to stabilize the client and prevent a seizure while preparing for delivery, which is the definitive treatment.

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A nurse is caring for a 28-year-old female client at approximately 10 weeks gestation presenting to the antepartum clinic. Exhibits Based on these findings, which laboratory value should the nurse review?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a 32-year-old female client, gravida 3, para 3, 14 hours status post vaginal delivery in the postpartum unit. Exhibits Complete the following sentence by using the list of options. The client is most likely experiencing dropdown due to dropdown .

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

What is the most likely cause of the client's symptoms, and what is the nurse's priority intervention?

Correct Answer is C

Explanation

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A nurse is caring for a 28-year-old female client at approximately 10 weeks gestation presenting to the antepartum clinic.

Exhibits
Based on these findings, which laboratory value should the nurse review?