A nurse is reviewing the electronic medical record of a female client, age 31, at 36 weeks of gestation in the antepartum unit.

Complete the following sentence by using the lists of options.
After reviewing the information in the client’s EMR, the nurse determines that the client is at risk for developing
__
as evidenced by
_
.

Answer and Explanation

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

The client is at risk for developing HELLP syndrome as evidenced by Liver enzymes.

Rationale for correct answers:
HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe form of preeclampsia often presenting in the third trimester. This client has thrombocytopenia (platelets 100,000/mm³; normal 150,000–400,000/mm³), elevated blood urea nitrogen (25 mg/dL; normal 10–20 mg/dL), borderline elevated creatinine (1.1 mg/dL; normal 0.5–1.0 mg/dL), and elevated uric acid (9.8 mg/dL; normal 2.7–7.3 mg/dL), which suggests possible renal impairment and oxidative stress typical in HELLP. Mild epigastric discomfort also aligns with liver involvement. Although liver enzymes are not listed in the labs here, the question implies liver enzyme elevation as a hallmark finding to confirm HELLP, which is essential to monitor. Hemolysis would typically manifest as anemia, but hemoglobin and hematocrit are near normal. Prompt recognition and further testing of liver enzymes (AST, ALT) are critical for diagnosis and management.

Rationale for incorrect Response 1 options:
Chorioamnionitis is an infection of the amniotic sac, usually presenting with fever, uterine tenderness, and elevated WBC, which are not present here. Gestational diabetes is characterized by hyperglycemia, but the client’s blood glucose is only mildly elevated and not diagnostic. Pyelonephritis involves urinary tract infection with systemic symptoms like fever and flank pain, absent in this case.

Rationale for incorrect Response 2 options:
Amniotic membrane status is unrelated here, as there is no rupture or infection evidence. Ketonuria reflects starvation or diabetes, which is not indicated. Blood glucose is only mildly elevated and insufficient to diagnose gestational diabetes or explain current symptoms.

Take home points:

HELLP syndrome involves low platelets, elevated liver enzymes, and hemolysis, often with epigastric pain.
Early lab monitoring including liver enzymes is vital for timely diagnosis.
Elevated BUN, creatinine, and uric acid can signal renal impairment in HELLP.
Differentiate HELLP from infections or gestational diabetes by clinical presentation and specific labs.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is ["A","C","D"]

Explanation

Choice A rationale

Vacuum-assisted delivery increases the risk of postpartum hemorrhage due to potential trauma to the birth canal and uterine atony caused by prolonged pressure or rapid extraction. The vacuum device can bruise the cervix, vagina, or perineum, leading to lacerations that bleed excessively. It can also overstretch uterine muscles, impairing their ability to contract effectively after birth.

Choice B rationale

A newborn weight of 2.948 kg (6 lb 8 oz) is within the normal weight range for a full-term infant. This weight does not typically pose an increased risk for postpartum hemorrhage. Larger infants (macrosomia, generally > 4 kg) are associated with higher risks due to increased uterine stretching and potential for prolonged labor or birth trauma.

Choice C rationale

Labor induction with oxytocin significantly increases the risk for postpartum hemorrhage, particularly due to uterine atony. Prolonged oxytocin administration can lead to desensitization of myometrial receptors, reducing the uterus's ability to contract effectively postpartum. This impaired contractility prevents compression of uterine blood vessels, resulting in excessive bleeding.

Choice D rationale

A history of uterine atony is a substantial risk factor for recurrent postpartum hemorrhage. Uterine atony is the most common cause of postpartum hemorrhage, accounting for a majority of cases. A prior history indicates a predisposition for the uterine musculature to fail in contracting adequately after birth, leading to uncontrolled blood loss.

Choice E rationale

A history of human papillomavirus (HPV) infection does not directly increase the risk of postpartum hemorrhage. HPV is a viral infection that primarily affects epithelial cells, often leading to genital warts or cervical dysplasia. It does not inherently alter uterine contractility, coagulation factors, or predispose to abnormal placental implantation, which are direct causes of hemorrhage.

A. Apply a new ice pack to the client's perineal area every 4 hours. B. Maintain a cool environment in the client's room. C. Provide the client with a warm beverage. D. Assist the client with showering twice daily.

Correct Answer is C

Explanation

Choice A rationale

Applying ice packs aligns with Western medical practices for reducing swelling and pain. However, traditional yin and yang beliefs often emphasize warmth during the postpartum period to restore a perceived loss of "hot" energy after childbirth. Cold applications could be seen as counterproductive to this balance.

Choice B rationale

Maintaining a cool environment would contradict the traditional belief in maintaining warmth for the postpartum client. In many cultures, a "hot-cold" theory dictates that the postpartum period is a "cold" state, requiring warmth to restore balance and prevent illness. A cool room would be perceived as harmful.

Choice C rationale

Providing a warm beverage aligns with traditional yin and yang postpartum care. Childbirth is often seen as a significant loss of "yang" energy (warmth, activity). Consuming warm foods and beverages helps to replenish this energy, promoting restoration of balance and preventing "cold" illnesses according to this belief system.

Choice D rationale

Showering twice daily, especially with cool water, might conflict with traditional postpartum practices that often restrict bathing or emphasize warm baths. The concern is often about preventing "cold" from entering the body and disrupting the balance, as well as conserving energy during a vulnerable period.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medical record of a client who had a vaginal delivery 3 hours ago. Which of the following findings place the client at risk for postpartum hemorrhage?

Correct Answer is ["A","C","D"]

Explanation

A nurse is planning care for a postpartum client who expresses a desire to follow the traditional beliefs regarding the balance of yin and yang for postpartum care. Which of the following actions should the nurse plan to take?

Correct Answer is C

Explanation

A nurse is caring for a client at a 10-week prenatal visit. The provider diagnoses the client with a missed spontaneous abortion confirmed by ultrasound and the nurse is discussing the plan of care with the client. Which of the following statements should the nurse make?

A nurse is caring for a client who is at 35 weeks of gestation and has preterm premature rupture of the membranes. Which of the following complications should the nurse monitor the newborn for following delivery?

A nurse is caring for a newborn in the neonatal unit following delivery. Complete the following sentence by using the list of options. The nurse should further evaluate ________ and ________ to determine if the newborn is experiencing a complication.

A nurse is assessing a newborn who is 2 hours old. Which of the following findings is an indication of hypoglycemia?

A nurse is providing teaching with an antepartum client who has a new diagnosis of genital herpes simplex virus 2 (HSV-2). Which of the following information should the nurse include?

A nurse is assessing a newborn immediately following a vaginal birth. For which of the following findings should the nurse intervene?

A nurse is caring for a client who is 9 hours postpartum following a cesarean birth with a quantitative blood loss of 1200 mL. Which of the following findings indicates the client is experiencing a fluid volume deficit?