A postpartum client on magnesium sulfate for preeclampsia suddenly developed severe headaches, floating spots in the field of vision, and right upper quadrant abdominal pain.
Vital signs are BP= 164/100, HR= 96, RR= 16. Laboratory results show liver enzymes are AST = 890, ALT= 980, and platelets = 25,000.This client most likely developed which condition?
HELLP Syndrome.
Postpartum hypertension.
Hypertension in pregnancy.
Superimposed preeclampsia.
The Correct Answer is A
Choice A rationale
The client’s symptoms and lab results are consistent with HELLP Syndrome, a severe form of preeclampsia. HELLP stands for Hemolysis, Elevated Liver enzymes, and Low Platelet count. The client’s elevated liver enzymes and low platelets, along with the reported symptoms, are indicative of this condition.
Choice B rationale
While the client’s high blood pressure could suggest Postpartum hypertension, the presence of severe headaches, visual disturbances, right upper quadrant pain, and abnormal lab results point more towards HELLP Syndrome.
Choice C rationale
Hypertension in pregnancy could be a possibility, but it does not explain all of the client’s symptoms and lab results, particularly the elevated liver enzymes and low platelets.
Choice D rationale
Superimposed preeclampsia is a condition where a pregnant woman with chronic hypertension develops preeclampsia. However, the client’s severe symptoms and lab results are more indicative of HELLP Syndrome.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is D. A client who experienced a cesarean birth 4 hr ago and reports pain. Pain after a cesarean birth could indicate complications such as infection or hemorrhage and should be addressed immediately.
Correct Answer is B
Explanation
Choice A rationale
Inserting an indwelling urinary catheter is not the priority nursing action. While it may be necessary later, especially if the client goes to surgery, it is not the immediate concern.
Choice B rationale
Initiating IV access is the correct action. The client is losing blood rapidly, has hypotension, and tachycardia. IV access will allow IV fluids and blood to be administered quickly if hypovolemia develops.
Choice C rationale
Witnessing the signature for informed consent for surgery is not the priority nursing action. While consent will be necessary if the client needs a cesarean section, the immediate concern is stabilizing the client.
Choice D rationale
Preparing the abdominal and perineal areas is not the priority nursing action. This would be done as part of surgical preparation if a cesarean section is needed, but it is not the immediate concern.
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