A nurse is caring for a client who is pregnant and has a history of heavy menstrual periods.
The nurse should identify which of the following findings warrants further testing for thrombophilia?
The client has mild thrombocytopenia.
The client's mother has Factor V Leiden.
The client's father had a pulmonary embolism.
The client's cousin has von Willebrand disease.
The Correct Answer is B
Choice A rationale
Mild thrombocytopenia, defined as a platelet count between 100,000 and 150,000/mm (normal range 150,000 to 450,000/mm), is common in pregnancy and often referred to as gestational thrombocytopenia. It is not a classic indicator of thrombophilia, which is a condition of excessive clotting rather than low platelet counts. While some autoimmune conditions like antiphospholipid syndrome can feature low platelets, isolated mild thrombocytopenia usually warrants observation rather than comprehensive thrombophilia screening unless other clinical symptoms are present.
Choice B rationale
A first-degree relative with Factor V Leiden is a significant indication for thrombophilia testing. Factor V Leiden is an autosomal dominant genetic mutation that makes the Factor V protein resistant to inactivation by activated protein C. This significantly increases the risk of venous thromboembolism during pregnancy, a naturally hypercoagulable state. Since the mutation is inherited, a maternal history of this specific factor strongly suggests the client may also carry the gene, necessitating diagnostic testing.
Choice C rationale
While a father having a pulmonary embolism indicates a family history of thrombosis, it is less specific for inherited thrombophilia than a confirmed genetic diagnosis like Factor V Leiden. A pulmonary embolism can be caused by acquired factors such as surgery, immobilization, or smoking. While it increases suspicion, clinical guidelines often prioritize testing when the family member's clot occurred at a young age or was unprovoked, or when a specific hereditary clotting mutation has already been identified in the family.
Choice D rationale
Von Willebrand disease is a bleeding disorder characterized by a deficiency or dysfunction of von Willebrand factor, which is necessary for platelet adhesion. It is the opposite of thrombophilia, which involves excessive clotting. While a family history of bleeding disorders is important for managing delivery and postpartum hemorrhage risks, it does not warrant testing for thrombophilia. Normal von Willebrand factor levels increase during pregnancy, which may temporarily mask mild forms of this specific bleeding disorder.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
A placenta that covers only a portion of the internal cervical os is classified as a partial placenta previa. In this condition, the placental edge extends over the opening but does not completely obstruct it. This differs from a marginal previa, where the placenta is located at the edge of the os rather than over it. Partial previa increases the risk of painless, bright red vaginal bleeding during the third trimester as the lower uterine segment thins.
Choice B rationale
When the placenta completely covers the internal cervical os, it is termed a total or complete placenta previa. This is the most severe form and necessitates a cesarean delivery because the placenta blocks the birth canal and is prone to massive hemorrhage if the cervix begins to dilate. Ultrasound would show the main body of the placenta centered directly over the cervical opening. This does not describe a marginal previa, where the placenta merely approaches the edge.
Choice C rationale
The location of the placenta on the anterior wall of the uterus refers to the anatomical site of implantation relative to the mother's front. While this information is important for surgical planning or performing an amniocentesis, it does not define the type of previa. Placenta previa is categorized based on its proximity to the cervical os, not its position on the anterior, posterior, or fundal walls of the uterus. Many normal pregnancies have anterior placental placement.
Choice D rationale
Marginal placenta previa is characterized by the placenta being implanted in the lower uterine segment such that its edge is near the internal cervical os but does not cover it. Specifically, the edge is typically within 2 cm of the os. As the cervix softens and effaces in late pregnancy or early labor, the proximity of the placental vessels to the opening can lead to bleeding. Ultrasound is the diagnostic tool used to measure this distance accurately.
Correct Answer is A
Explanation
Choice A rationale
Pregestational type 1 diabetes presents the most significant challenges during pregnancy due to the long-term systemic effects of the disease. Chronic hyperglycemia during the critical period of organogenesis increases the risk of congenital malformations and spontaneous abortion. Furthermore, these clients often have pre-existing vascular or renal damage, which significantly raises the likelihood of developing preeclampsia and placental insufficiency, leading to higher rates of maternal and fetal morbidity compared to other diabetic types.
Choice B rationale
This statement is scientifically inaccurate because pregestational diabetes actually carries a much higher risk of complications than gestational diabetes. In pregestational cases, the fetus is exposed to fluctuations in maternal blood glucose levels from the moment of conception. This exposure can lead to macrosomia, neonatal hypoglycemia, and respiratory distress syndrome. Maternal risks include ketoacidosis and retinopathy progression. Managing these risks requires intensive glycemic control and frequent monitoring throughout the entire gestational period.
Choice C rationale
Pregestational diabetes is a chronic, lifelong metabolic disorder characterized by the absolute or relative lack of insulin production. Unlike gestational diabetes, which often resolves after the placenta is delivered and hormone levels normalize, pregestational type 1 or type 2 diabetes persists indefinitely. Postpartum management remains essential to prevent long-term complications such as neuropathy, nephropathy, and cardiovascular disease. Telling a client it will not require management after birth is dangerous and medically incorrect.
Choice D rationale
Epidemiological data indicates that the risk of developing gestational diabetes mellitus increases with maternal age. Clients who are over the age of 25 to 30 years are at a significantly higher risk compared to those in their early twenties. While gestational diabetes can occur at any age, advanced maternal age is a well-documented independent risk factor due to declining pancreatic beta-cell function and increased insulin resistance that often accompanies the aging process in reproductive years.
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