Nokea
A high-risk labor patient progresses from preeclampsia to eclampsia. Aggressive management is instituted, and the fetus is delivered via cesarean birth. Which finding in the immediate postoperative period indicates that the patient is at risk of developing HELLP syndrome?
- A. Platelet count of 50,000/mcL
- B. Liver enzyme levels within normal range
- C. Negative for edema
- D. No evidence of nausea or vomiting
Correct Answer: A
Rationale: The correct answer is A: Platelet count of 50,000/mcL. In HELLP syndrome, there is hemolysis, elevated liver enzymes, and low platelet count. A platelet count of 50,000/mcL indicates thrombocytopenia, a key feature of HELLP syndrome. It signifies ongoing coagulation abnormalities and liver dysfunction.
B: Liver enzyme levels within normal range is incorrect as HELLP syndrome typically presents with elevated liver enzymes.
C: Negative for edema is incorrect as edema is not a defining characteristic of HELLP syndrome.
D: No evidence of nausea or vomiting is incorrect as these symptoms are not specific to HELLP syndrome.
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Several hours after delivery, a new mother expresses ambivalence regarding her infant. How will the nurse promote bonding?
- A. Having the mother feed the infant
- B. Removing the infant from the mother's arms if it cries
- C. Positioning the infant so its head rests on the mother's shoulder
- D. Encouraging the mother to sleep for 4 to 6 hours before interacting with the infant
Correct Answer: A
Rationale: The correct answer is A, having the mother feed the infant. This helps promote bonding through physical closeness, eye contact, and the release of oxytocin. Feeding also fosters a sense of responsibility and nurturing. Choice B may disrupt bonding by creating separation anxiety. Choice C is a comforting position but not as interactive as feeding. Choice D delays bonding and can impact the establishment of a strong maternal-infant relationship.
The nurse applies fetal and uterine monitors to the abdomen of a client in active labor. When the client has contractions, the nurse notes a 15 beats/min deceleration of the fetal heart rate below the baseline lasting 15 seconds. Which is the next nursing action?
- A. Calling the primary health care provider
- B. Changing the maternal position
- C. Obtaining the maternal blood pressure
- D. Preparing the environment for an immediate birth
Correct Answer: B
Rationale: The correct answer is B: Changing the maternal position. Deceleration of fetal heart rate during contractions can indicate umbilical cord compression. Changing the maternal position can relieve pressure on the cord, improving blood flow to the fetus. This action is a non-invasive and immediate intervention that can potentially improve fetal oxygenation. Calling the primary health care provider (A) can be done after addressing the immediate concern. Obtaining maternal blood pressure (C) is not the priority in this situation. Preparing for an immediate birth (D) is premature without first attempting non-invasive interventions.
Which factor is known to increase the risk of gestational diabetes mellitus?
- A. Previous birth of large infant
- B. Maternal age younger than 25 years
- C. Underweight prior to pregnancy
- D. Previous diagnosis of type 2 diabetes mellitus
Correct Answer: A
Rationale: The correct answer is A: Previous birth of large infant. This factor increases the risk of gestational diabetes mellitus due to the association with maternal insulin resistance. Large infants may have been exposed to higher glucose levels in utero, leading to increased risk in subsequent pregnancies. Maternal age younger than 25 years (B) is not a known risk factor. Being underweight prior to pregnancy (C) is actually associated with a lower risk of gestational diabetes. Previous diagnosis of type 2 diabetes mellitus (D) is a separate condition and not a risk factor for gestational diabetes.
Which intrapartal assessment should be avoided when caring for a patient with HELLP syndrome?
- A. Abdominal palpation
- B. Venous sample of blood
- C. Checking deep tendon reflexes
- D. Auscultation of the heart and lungs
Correct Answer: A
Rationale: Correct Answer: A - Abdominal palpation
Rationale: Abdominal palpation can lead to increased risk of placental abruption in patients with HELLP syndrome. This can cause severe hemorrhage and compromise fetal and maternal well-being. Therefore, it should be avoided.
Summary of other choices:
- B: Venous sample of blood: Necessary for assessing blood parameters in patients with HELLP syndrome.
- C: Checking deep tendon reflexes: Important for evaluating neurological status in patients with HELLP syndrome.
- D: Auscultation of the heart and lungs: Essential for monitoring cardiovascular and respiratory function in patients with HELLP syndrome.
The health-care provider is caring for an adolescent patient who is pregnant. The health-care provider knows that pregnancy during adolescence is linked with what influencing factor or factors? Select all that apply.
- A. low socioeconomic status
- B. psychologic problems
- C. social problems
- D. unemployment
Correct Answer: A,B,C
Rationale: A: Low socioeconomic status is a contributing factor to adolescent pregnancy due to limited access to education, healthcare, and contraception. B: Psychologic problems such as low self-esteem or mental health issues can increase the likelihood of adolescent pregnancy. C: Social problems like lack of support from family or peers, or exposure to risky behaviors, can also influence adolescent pregnancy. D: Unemployment, while a potential issue, is not directly linked to adolescent pregnancy as the other factors are more significant in this context.