Review Practice Exercise 3

Hypertensive Disorders > Maternal Newborn

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Practice Exercise 3

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Total Questions : 5

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Question 1:

A 28-year-old primigravida at 34 weeks gestation presents with new-onset BP 150/98 mmHg and 2+ proteinuria. Which of the following is the most likely diagnosis?

A. Gestational hypertension B. Chronic hypertension C. Preeclampsia without severe features D. Preeclampsia with severe features

Answer and Explanation

Choice A:

Gestational hypertension is defined as new-onset hypertension after 20 weeks gestation without proteinuria or systemic signs. This patient has 2+ proteinuria, which excludes gestational hypertension. The presence of proteinuria and systemic involvement rules out this diagnosis.

Choice B:

Chronic hypertension is diagnosed when elevated BP is present before pregnancy or before 20 weeks gestation. This patient is a primigravida at 34 weeks with new-onset hypertension, making chronic hypertension unlikely. The timing and absence of prior history exclude chronic hypertension.

Choice C:

The patient is at 34 weeks gestation with new-onset BP of 150/98 mmHg and 2+ proteinuria, meeting criteria for preeclampsia. There are no signs of severe features such as BP ≥160/110 mmHg, thrombocytopenia, elevated creatinine, or neurological symptoms. The absence of these severe features and the presence of proteinuria confirm preeclampsia without severe features.

Choice D:

Preeclampsia with severe features requires either BP ≥160/110 mmHg or evidence of end-organ damage. This patient’s BP is 150/98 mmHg and there are no signs of thrombocytopenia, renal dysfunction, or neurological symptoms. The lack of end-organ damage and severe hypertension makes this diagnosis incorrect.

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Question 2:

Which laboratory finding is indicative of hemolysis in HELLP syndrome?

A. Elevated platelet count B. Decreased lactate dehydrogenase C. Presence of schistocytes on peripheral smear D. Normal haptoglobin levels

Answer and Explanation

Choice A:

Elevated platelet count is not consistent with HELLP syndrome. Thrombocytopenia (<100,000/µL) is a defining feature due to platelet consumption and vascular injury. An elevated count would argue against the diagnosis.

Choice B:

Decreased lactate dehydrogenase is incorrect. LDH is released during cell lysis and is typically elevated (>600 IU/L) in HELLP due to hemolysis and hepatic injury. A decreased level would not support the diagnosis.

Choice C:

Schistocytes are fragmented red blood cells seen in microangiopathic hemolytic anemia, a hallmark of HELLP syndrome. Their presence on peripheral smear confirms intravascular hemolysis due to endothelial damage, making this the most specific laboratory finding.

Choice D:

Normal haptoglobin levels are not indicative of hemolysis. Haptoglobin binds free hemoglobin and is consumed during hemolysis, leading to low levels. Normal levels suggest absence of significant red cell destruction.

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Question 3:

Which of the following findings would indicate that preeclampsia has severe features? Select all that apply

A. Platelet count 90,000/μL B. Serum creatinine 1.5 mg/dL C. Report of temporary blindness D. BP 145/95 mmHg E. Urine output 700 mL/24h

Answer and Explanation

Choice A:

A platelet count of 90,000/μL meets the criterion for thrombocytopenia (<100,000/μL), indicating vascular injury and platelet consumption, consistent with severe features.

Choice B:

Serum creatinine of 1.5 mg/dL exceeds the threshold of >1.1 mg/dL or doubling of baseline, indicating renal impairment and end-organ dysfunction, a hallmark of severe preeclampsia.

Choice C:

Temporary blindness reflects cerebral involvement and neurological dysfunction, which are considered severe features due to risk of eclampsia and stroke.

Choice D:

BP of 145/95 mmHg does not meet the threshold for severe hypertension (≥160/110 mmHg). While elevated, it reflects moderate hypertension and lacks the pressure level required to classify as severe. Without accompanying end-organ signs, this BP alone is insufficient.

Choice E:

Urine output of 700 mL/24h is reduced but not below the strict oliguria threshold (<500 mL/24h). However, it suggests renal hypoperfusion and progressive dysfunction, which may be considered a severe feature in clinical context.

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Question 4:

Which fetal complication is associated with hypertensive disorders in pregnancy?

A. Macrosomia B. Intrauterine growth restriction C. Polyhydramnios D. Congenital heart defects

Answer and Explanation

Choice A:

Macrosomia is typically associated with maternal diabetes, not hypertension. It results from hyperglycemia-induced fetal hyperinsulinemia, promoting excessive growth. Hypertensive pregnancies more commonly lead to restricted growth, not overgrowth.

Choice B:

Intrauterine growth restriction occurs due to impaired placental perfusion and chronic fetal hypoxia caused by maternal hypertension. The fetus receives inadequate nutrients and oxygen, leading to reduced growth velocity and low estimated fetal weight.

Choice C:

Polyhydramnios is linked to fetal anomalies (e.g., anencephaly), maternal diabetes, or idiopathic causes. Hypertensive disorders often cause oligohydramnios due to reduced placental function and fetal urine output, not excess fluid.

Choice D:

Congenital heart defects are not directly caused by maternal hypertension. They are more often associated with genetic syndromes or teratogenic exposures during organogenesis. Hypertension affects placental function but not structural fetal development.

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Question 5:

A nurse is caring for a client with HELLP syndrome. Which laboratory findings are expected? Select all that apply

A. Elevated LDH B. Decreased platelet count C. Elevated AST/ALT D. Elevated haptoglobin E. Decreased bilirubin

Answer and Explanation

Choice A:

Elevated LDH reflects cellular breakdown and hemolysis, a hallmark of HELLP. LDH >600 IU/L is a diagnostic marker due to red cell destruction and hepatic injury.

Choice B:

Decreased platelet count (<100,000/μL) is due to platelet consumption and vascular damage, fulfilling the “LP” component of HELLP.

Choice C:

Elevated AST/ALT indicates hepatic injury from microvascular damage and fibrin deposition. Levels often exceed 70 IU/L, confirming liver involvement.

Choice D:

Elevated haptoglobin is not expected. Haptoglobin binds free hemoglobin and is consumed during hemolysis, leading to low levels. Elevated values suggest absence of red cell destruction.

Choice E:

Decreased bilirubin is incorrect. Hemolysis increases unconjugated bilirubin, so levels are typically elevated. A decrease would not reflect hemolytic activity.

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