A pregnant client, at 16 weeks' gestation, has a hematocrit of 34%. Her pre-pregnancy hematocrit was 40%. Which of the following statements by the nurse best explains this change?
Because of your pregnancy, you're not making enough red blood cells.
You're not eating enough iron-rich foods like meat.
This change may indicate a serious problem that might harm your baby.
Because your blood plasma volume has increased, your hematocrit count is lower.
The Correct Answer is D
Choice A rationale
During pregnancy, the body’s production of red blood cells usually increases to meet the increased demands of the growing fetus. Therefore, a drop in hematocrit is not typically due to insufficient red blood cell production.
Choice B rationale
While iron is essential during pregnancy, a reduction in hematocrit levels at 16 weeks' gestation is primarily due to increased plasma volume, rather than iron deficiency. Nutritional counseling may still be beneficial but isn't the primary explanation for this change.
Choice C rationale
A hematocrit level of 34% at 16 weeks is generally not considered indicative of a severe problem. Instead, it is a physiological response to increased plasma volume, known as dilutional anemia of pregnancy.
Choice D rationale
The primary reason for a lower hematocrit count during pregnancy is the increase in blood plasma volume, leading to dilutional anemia. This is a normal adaptation to pregnancy that ensures adequate blood flow to the fetus.
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Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
Choice A rationale
Rubella vaccination is contraindicated during pregnancy due to the risk of congenital rubella syndrome in the fetus. It should be administered postpartum if the client is non-immune.
Choice B rationale
Preterm labor is a concern at 28 weeks' gestation. Educating the client on signs and symptoms can help in early detection and management, potentially improving outcomes for both mother and baby.
Choice C rationale
Rh-negative mothers with a negative antibody screen should receive Rhogam at 28 weeks to prevent Rh sensitization. This is crucial to avoid hemolytic disease of the newborn in future pregnancies.
Choice D rationale
A positive urine analysis for leukocytes indicates a possible urinary tract infection. A clean catch urine culture is needed to identify the causative organism and guide appropriate antibiotic therapy.
Choice E rationale
The glucose challenge test result of 120 at 26 weeks is within normal limits, but a 3-hour diagnostic glucose tolerance test may be ordered if there's a high index of suspicion for gestational diabetes or other risk factors.
Choice F rationale
A blood transfusion is not indicated as the hemoglobin/hematocrit levels (11.0 mg/dl and 35%) are within acceptable limits for pregnancy.
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"C"},"D":{"answers":"A"},"E":{"answers":"A"}}
Explanation
Weight loss of 2.8 kg (6.2 lb): Consistent - Significant weight loss is a classic symptom of hyperemesis gravidarum. The client has lost more than 5% of her pre-pregnancy weight, which is concerning and supports this diagnosis.
Hematocrit: 30%: Not Consistent - Hematocrit measures the proportion of red blood cells in the blood. In hyperemesis gravidarum, the hematocrit may be elevated due to dehydration, not decreased. Therefore, this value is not consistent with the typical presentation.
Vaginal spotting: Not Relevant - While vaginal spotting can be concerning in pregnancy, it is not a specific sign of hyperemesis gravidarum and does not directly relate to the diagnosis of severe nausea and vomiting.
Heart rate: 110/min: Consistent - Tachycardia (elevated heart rate) can occur due to dehydration and the body’s response to prolonged vomiting, making this finding consistent with hyperemesis gravidarum.
BUN: 28 mg/dL: Consistent - Blood urea nitrogen (BUN) is elevated in this client, suggesting dehydration. Dehydration is a common complication of hyperemesis gravidarum due to persistent vomiting and poor oral intake.
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