Difficulty: Medium
Average Score: 83%
Simulated
Passage / Scenario
The nurse in the emergency department is caring for a 37-year-old female client.ÔÇó History and Physical
0830: A 37-year-old nulliparous woman at 36 weeks gestation presents to the emergency department with complaints of severe headache, blurred vision, and upper abdominal pain. She reports feeling generally unwell and fatigued for the past 24 hours. Her pregnancy has been uncomplicated until now, with consistent prenatal care. On arrival, her vital signs are: blood pressure 160/100 mmHg, heart rate 88 bpm, respiratory rate 20 breaths per minute, temperature 98.6┬░F (37┬░C), and oxygen saturation 98% on room air. Physical exam reveals mild lower extremity edema and no signs of trauma. Fetal monitoring shows a baseline heart rate of 150 bpm with moderate variability, no accelerations, and no decelerations. The client has no uterine contractions.
Orders
0830
ÔÇó Complete Blood Count (CBC)
ÔÇó Comprehensive Metabolic Panel (CMP)
ÔÇó Urinalysis (UA)
ÔÇó Continuous Fetal Monitoring
The nurse is waiting for the laboratory data to arrive in the clientÔÇÖs electronic health record, but suspects that the client is experiencing preeclampsia.For each laboratory test, indicate whether the result will likely be increased or decreased in the pregnant client with preeclampsia.Each row must have one (1) response option selected.
Rationale
In clients with preeclampsia, a series of physiological events is grounded in a reduction in perfusion. This includes an elevation of the liver enzymes, LDH, AST, and ALT.
Reduced kidney perfusion decreases the glomerular filtration rate and can lead to degenerative glomerular changes and oliguria, manifested by increased blood urea nitrogen (BUN) and creatinine levels.
The platelet count decreases as a result of the hemodilution present in pregnancy, as well as an increase in hemolysis. The elevated rate of platelet destruction is caused by the increase in the size of the spleen and its rate of platelet destruction from a higher blood volume that accompanies pregnancy.
Reduced kidney perfusion decreases the glomerular filtration rate and can lead to degenerative glomerular changes and oliguria, manifested by increased blood urea nitrogen (BUN) and creatinine levels.
The platelet count decreases as a result of the hemodilution present in pregnancy, as well as an increase in hemolysis. The elevated rate of platelet destruction is caused by the increase in the size of the spleen and its rate of platelet destruction from a higher blood volume that accompanies pregnancy.