The nurse is reviewing the findings.

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

Blood pressure

Platelet count

Alanine aminotransferase (ALT)

Hemoglobin

Answer and Explanation

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

Blood pressure: The client's significantly elevated blood pressure (162/112 mm Hg and 166/110 mm Hg) is characteristic of preeclampsia, which is defined by new-onset hypertension after 20 weeks of gestation. Hypertension is a major diagnostic criterion for preeclampsia but is not required for diagnosing HELLP syndrome.
Platelet count: The platelet count of 98,000/mm³ is lower than normal, supporting both preeclampsia and HELLP syndrome. In preeclampsia, thrombocytopenia can occur as the disease progresses, and in HELLP syndrome, low platelets are one of the triad components (Hemolysis, Elevated Liver enzymes, Low Platelet count).
Alanine aminotransferase (ALT): An ALT level of 40 Units/L is above the normal limit, indicating liver involvement. Elevated liver enzymes occur in both severe preeclampsia and HELLP syndrome, reflecting hepatic dysfunction or injury caused by systemic endothelial damage.
Hemoglobin: A hemoglobin of 18.0 g/dL is unusually high and suggests hemoconcentration, which is typical of preeclampsia due to fluid shifts out of the vascular space. In contrast, HELLP syndrome typically causes hemolysis leading to anemia, where hemoglobin would be expected to be low rather than elevated.

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Correct Answer is "{\"xRanges\":[111.828125,122.828125],\"yRanges\":[106.5,117.5]}"

Explanation

A: Location A is near the infant’s foot, specifically around the ankle. This area is where the posterior tibial or dorsalis pedis pulse would be palpated, not the femoral pulse. These pulses are important for assessing peripheral circulation but are not the primary site for evaluating coarctation of the aorta, which requires checking central pulses like the femoral.

B: Location B is at the upper inner thigh, near the groin, where the femoral artery passes close to the skin surface. This is the correct site for palpating the femoral pulse in an infant. In conditions like coarctation of the aorta, comparing the strength of the brachial and femoral pulses is crucial to detect differences in blood flow between the upper and lower body.

C: Location C is on the upper arm, near the shoulder area, which corresponds to the location for checking the brachial pulse. The brachial pulse is commonly used in infants to assess heart rate, especially during resuscitation efforts. However, it is not the site for assessing femoral pulse strength, which is needed when evaluating for coarctation of the aorta.

A. Open nearby doors and windows when the fire alarm sounds B. Attempt to extinguish the fire before evacuating clients. C. Have ambulatory clients walk independently to a safe location D. Aim the spray of the fire extinguisher at the top of the fire.

Correct Answer is C

Explanation

A. Open nearby doors and windows when the fire alarm sounds: Opening doors and windows during a fire can cause the fire to spread more rapidly by feeding it with additional oxygen. Doors should be closed to contain the fire and reduce the spread of smoke.

B. Attempt to extinguish the fire before evacuating clients: Client safety is the priority in a fire situation. Evacuation should occur first, and attempts to extinguish the fire should only be made if it is safe to do so without putting clients or staff at risk.

C. Have ambulatory clients walk independently to a safe location: Ambulatory clients should be instructed to evacuate independently if they can do so safely, freeing staff to assist clients who are immobile or require more help during the evacuation.

D. Aim the spray of the fire extinguisher at the top of the fire: The proper technique is to aim at the base of the fire, not the top, to effectively extinguish the flames by removing the fire's source of fuel.

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The nurse is reviewing the findings. For each 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

Correct Answer is "{\"xRanges\":[111.828125,122.828125],\"yRanges\":[106.5,117.5]}"

Explanation

A nurse is reinforcing teaching about the facility's fire intervention plan with new assistive personnel. Which of the following instructions should the nurse include in the teaching?

Correct Answer is C

Explanation

A nurse is collecting data from a client who reports manifestations of depression. Which of the following findings should the nurse identify as a risk factor for suicide?

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The nurse has reviewed the Nurses' Notes and Vital Signs at 1200. Which of the following 2 findings indicate that the client is experiencing a complication after the procedure?

The nurse is reviewing the findings.

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