The nurse is continuing to care for the client.

Exhibits

The nurse is reviewing the assessment findings.

For each assessment finding, click to specify if the finding is consistent with preeclampsia or HELLP syndrome. Each finding may support more than one disease process.

Platelet count

Alanine aminotransferase (ALT)

Blood pressure

Hemoglobin

Answer and Explanation

The Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"B"},"C":{"answers":"A,B"},"D":{"answers":"B"}}

Rationale:

Platelet count: A low platelet count (<100,000/mm³) is a hallmark of HELLP syndrome but can also appear in severe preeclampsia. Therefore, thrombocytopenia supports both diagnoses.
Alanine aminotransferase (ALT): Elevated ALT indicates hepatic involvement due to hepatocellular injury, which is a defining feature of HELLP syndrome but not required for preeclampsia diagnosis.
Blood pressure: Severe hypertension (≥160/110 mm Hg), as seen in this client, is diagnostic of severe preeclampsia. It may also be present in HELLP syndrome due to overlapping pathophysiology.
Hemoglobin: Low hemoglobin can reflect hemolysis, which is part of the HELLP acronym (Hemolysis, Elevated Liver enzymes, Low Platelets). Preeclampsia does not typically present with anemia unless HELLP develops.

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Correct Answer is B

Explanation

Rationale:

A. "I will avoid strenuous exercise.": Physical activity, including regular moderate exercise like walking, actually helps stimulate bowel function. Avoiding exercise may worsen constipation rather than prevent it.

B. "I will increase my intake of high-fiber foods.": A high-fiber diet supports regular bowel movements by increasing stool bulk and promoting peristalsis. This is a key strategy for preventing opioid-induced constipation.

C. "I will take a bulk-forming laxative every day.": Bulk-forming laxatives can be helpful, but daily use should be discussed with a provider, as they can worsen constipation if fluid intake is insufficient. Dietary changes are usually the first recommended step.

D. "I will limit my fluid intake to 1 liter per day.": Limiting fluid intake can lead to dehydration and hard stools, worsening constipation. Adequate hydration is essential to help fiber work effectively and support regular bowel function.

A. Frequent swallowing B. Increased drowsiness C. Elevated pain level D. Diminished breath sounds

Correct Answer is A

Explanation

Rationale:

A. Frequent swallowing: Frequent swallowing, especially of small amounts, can indicate that the child is swallowing blood from postoperative bleeding. This is a common early sign of hemorrhage following a tonsillectomy and requires immediate evaluation.

B. Increased drowsiness: Drowsiness can result from anesthesia, pain medication, or fatigue after surgery. While it should be monitored, it is not a specific indicator of postoperative hemorrhage in a child following tonsillectomy.

C. Elevated pain level: Pain is expected after tonsillectomy and does not necessarily signal bleeding. Sudden severe pain might warrant reassessment, but elevated pain alone is not a definitive sign of hemorrhage.

D. Diminished breath sounds: Diminished breath sounds are not typically associated with post-tonsillectomy hemorrhage. This finding may indicate a respiratory issue, but not specifically bleeding from the surgical site.

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The nurse is continuing to care for the client. Exhibits The nurse is reviewing the assessment findings. For each assessment finding, click to specify if the finding is consistent with preeclampsia or HELLP syndrome. Each finding may support more than one disease process.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching about preventing constipation to a client who has a new prescription for oxycodone. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is B

Explanation

A nurse is caring for a child who is postoperative following a tonsillectomy. Which of the following findings indicates that the child may be experiencing hemorrhage?

Correct Answer is A

Explanation

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A nurse is caring for the client.Exhibits Select the 5 findings that indicate the client's condition has improved.

The nurse is continuing to care for the client.

Exhibits

The nurse is reviewing the assessment findings.

For each assessment finding, click to specify if the finding is consistent with preeclampsia or HELLP syndrome. Each finding may support more than one disease process.