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The prenatal clinic nurse is monitoring women for preeclampsia.
If all four women were in the clinic at the same time, which one should the nurse see first?

A.

A dipstick value of 3+ for protein in her urine.

B.

Pitting pedal edema at the end of the day.

C.

Blood pressure increase to 138/86 mm Hg.

D.

Weight gain of 0.5 kg during the past 2 weeks.

Answer and Explanation

The Correct Answer is A

Choice A rationale

A dipstick value of 3+ for protein in the urine is a significant indicator of proteinuria, a key diagnostic criterion for preeclampsia. Preeclampsia is characterized by new-onset hypertension and proteinuria or other signs of end-organ damage in a previously normotensive pregnant woman. A 3+ protein level suggests substantial protein spillage into the urine, necessitating immediate attention to assess the severity of preeclampsia and prevent potential complications for both the mother and the fetus. Normal urine protein is typically negative to trace amounts.

Choice B rationale

Pitting pedal edema at the end of the day can be a common finding in pregnancy due to increased blood volume and pressure on the veins in the legs. While edema can be associated with preeclampsia, it is not a primary diagnostic criterion and can occur in normal pregnancies. Therefore, isolated pedal edema without other signs of preeclampsia is less concerning than significant proteinuria.

Choice C rationale

A blood pressure reading of 138/86 mm Hg is mildly elevated and falls within the range for stage 1 hypertension. While hypertension is a diagnostic criterion for preeclampsia, this isolated reading without a significant increase from baseline or other preeclampsia symptoms may not be the most urgent concern compared to significant proteinuria. Preeclampsia diagnosis requires a blood pressure of ≥140 mm Hg systolic or ≥90 mm Hg diastolic on two occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive woman.

Choice D rationale

A weight gain of 0.5 kg (approximately 1.1 pounds) over two weeks is within the expected range for weight gain during pregnancy. While rapid or excessive weight gain can be a sign of fluid retention associated with preeclampsia, a modest gain of 0.5 kg over two weeks is not a primary indicator of the condition and is less concerning than significant proteinuria.


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Related Questions

Correct Answer is C

Explanation

Choice A rationale

Hyperemesis gravidarum is severe nausea and vomiting during pregnancy, typically occurring in the first trimester. Amniocentesis is a procedure performed later in pregnancy, so hyperemesis is not a direct complication of the procedure.

Choice B rationale

Proteinuria is the presence of protein in the urine, which can be a sign of preeclampsia during pregnancy. While amniocentesis carries a small risk of complications, proteinuria is not a direct expected complication of the procedure itself.

Choice C rationale

Hemorrhage, or excessive bleeding, is a potential complication of amniocentesis because the procedure involves inserting a needle through the abdominal wall and uterus to withdraw amniotic fluid. This can potentially damage blood vessels, leading to bleeding at the insertion site or internally.

Choice D rationale

Hypoxia is a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level. While fetal well-being is monitored during and after amniocentesis, hypoxia is not a direct complication for the mother.

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

Explanation

Rationales for Each Condition

Neonatal Abstinence Syndrome (NAS)

  1. Temperature: Infants experiencing NAS often have difficulty regulating body temperature due to autonomic instability. While the newborn's temperature of 36.6°C (97.9°F) is within normal range, the use of a radiant warmer suggests challenges in maintaining thermoregulation, which is characteristic of NAS.
  2. Jitteriness: Jitteriness is observed in both hypoglycemia and NAS. In NAS, it is caused by neurological excitability due to opioid withdrawal, leading to tremors and hypertonia, which improve with soothing measures such as swaddling.
  3. Skin Color: Mottling is a frequent sign in neonates experiencing opioid withdrawal due to autonomic dysregulation. The absence of cyanosis or jaundice indicates that the mottling is due to withdrawal rather than an underlying pathology.
  4. GI Assessment: Loose stools and hyperactive bowel sounds are typical signs of NAS, caused by increased gastrointestinal motility due to withdrawal from opioids.

Hypoglycemia

  1. Jitteriness: Hypoglycemia is characterized by neuromuscular instability, leading to jitteriness. However, in this case, the newborn’s blood glucose level of 45 mg/dL is within acceptable neonatal range, making NAS a more likely explanation.
  2. Temperature, Skin Color, and GI Assessment: Hypoglycemia does not typically cause mottled skin or loose stools, making these findings more consistent with NAS.

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