Review Practice Exercise 5

Hypertensive Disorders > Maternal Newborn

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Practice Exercise 5

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Total Questions : 5

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Question 1:

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. Instead, thrombocytopenia is a hallmark feature, often <100,000/mm³, due to platelet consumption in microvascular injury. An elevated count suggests absence of platelet destruction, ruling out HELLP.

Choice B:

Decreased lactate dehydrogenase contradicts the pathophysiology. LDH is released during cellular breakdown, especially from red blood cells and hepatocytes. In HELLP, LDH is typically elevated >600 IU/L due to ongoing hemolysis and liver injury. A decrease would suggest no active hemolysis.

Choice C:

Schistocytes are fragmented red blood cells seen on peripheral smear, indicating microangiopathic hemolytic anemia. Their presence confirms intravascular destruction due to endothelial damage and fibrin strands in HELLP syndrome. This is a direct marker of hemolysis, making it the most specific laboratory finding among the options.

Choice D:

Normal haptoglobin levels are not expected in HELLP syndrome. Haptoglobin binds free hemoglobin released during intravascular hemolysis. In HELLP, levels are decreased due to consumption. Normal values (30–200 mg/dL) would argue against active hemolysis.

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Question 2:

A nurse is caring for a client diagnosed with HELLP syndrome. The client suddenly complains of severe right upper quadrant pain. The nurse suspects which potentially life-threatening complication?

A. Pulmonary embolism B. Placental abruption C. Hepatic subcapsular hematoma or rupture D. Deep vein thrombosis

Answer and Explanation

Choice A:

Pulmonary embolism presents with pleuritic chest pain, dyspnea, and tachypnea, not localized right upper quadrant pain. Although HELLP increases thrombotic risk, PE does not cause hepatic capsule pain or liver rupture. No respiratory symptoms are described, making this less likely.

Choice B:

Placental abruption causes vaginal bleeding, uterine tenderness, and fetal distress, not right upper quadrant pain. It results from premature placental separation, often with hypertension, but does not involve hepatic pathology. The pain described is not uterine or lower abdominal.

Choice C:

Hepatic subcapsular hematoma or rupture is a known life-threatening complication of HELLP syndrome. Severe right upper quadrant pain reflects hepatic distension or bleeding. The liver capsule stretches due to hematoma formation, and rupture may lead to hemoperitoneum and hypovolemic shock. This is an obstetric emergency requiring immediate surgical and supportive intervention.

Choice D:

Deep vein thrombosis presents with unilateral leg swelling, pain, and erythema, not right upper quadrant pain. While HELLP increases clot risk, DVT does not cause hepatic symptoms or liver rupture. No limb findings are noted in the scenario.

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Question 3:

Which of the following are components of HELLP syndrome? Select all that apply

A. Hemolysis B. Elevated liver enzymes C. Hypoglycemia D. Low platelet count E. Hypertension

Answer and Explanation

Choice A:

Hemolysis is a core diagnostic criterion of HELLP syndrome. It results from microvascular injury and fibrin deposition causing red cell fragmentation. Laboratory markers include schistocytes on smear, elevated LDH, and decreased haptoglobin.

Choice B:

Elevated liver enzymes reflect hepatocellular damage due to periportal necrosis and microvascular thrombosis. AST and ALT levels typically exceed 70 IU/L. This hepatic involvement contributes to right upper quadrant pain and risk of subcapsular hematoma.

Choice C:

Hypoglycemia is not a component of HELLP syndrome. Glucose metabolism is not directly affected. In contrast, hyperglycemia may occur in gestational diabetes. HELLP affects liver and coagulation, not insulin regulation or glucose levels.

Choice D:

Low platelet count (<100,000/mm³) is a defining feature due to platelet consumption in damaged vasculature. Thrombocytopenia increases bleeding risk and may progress to DIC. It is essential for diagnosis and guides urgency of delivery.

Choice E:

Hypertension is common in preeclampsia but not a diagnostic criterion of HELLP syndrome. While many patients with HELLP have elevated blood pressure, normotensive cases exist. Diagnosis relies on hemolysis, liver enzymes, and platelets—not blood pressure.

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Question 4:

The definitive treatment for both preeclampsia and HELLP syndrome is:

A. Administration of corticosteroids B. Strict bed rest C. Delivery of the placenta D. Long-term antihypertensive therapy

Answer and Explanation

Choice A:

Administration of corticosteroids may improve fetal lung maturity and transiently stabilize maternal labs, but it is not curative. Steroids do not reverse endothelial injury or halt placental factor release. They are adjunctive, not definitive treatment.

Choice B:

Strict bed rest does not alter the underlying pathophysiology. It may reduce blood pressure transiently but does not prevent progression to eclampsia, DIC, or hepatic rupture. Bed rest is outdated and not evidence-based as a primary intervention.

Choice C:

Delivery of the placenta is the definitive treatment because it removes the source of antiangiogenic factors and inflammatory mediators. This halts endothelial damage and reverses systemic effects. In HELLP syndrome, delivery is urgent if gestational age is ≥34 weeks or maternal status deteriorates. It is the only intervention that stops disease progression.

Choice D:

Long-term antihypertensive therapy manages blood pressure but does not treat the root cause—placental dysfunction. It may reduce stroke risk but cannot prevent worsening hemolysis, liver injury, or thrombocytopenia. Antihypertensives are supportive, not curative.

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Question 5:

Which of the following are appropriate nursing interventions for a patient with HELLP syndrome? Select all that apply

A. Monitor for signs of bleeding B. Administer insulin C. Encourage ambulation D. Restrict fluid intake E. Monitor liver function tests

Answer and Explanation

Choice A:

Monitoring for signs of bleeding is critical due to thrombocytopenia and risk of DIC. Platelet counts <100,000/mm³ increase hemorrhage risk. Nurses must assess for petechiae, bruising, hematuria, and vaginal bleeding.

Choice B:

Administering insulin is not indicated unless the patient has gestational diabetes. HELLP syndrome does not involve glucose dysregulation. Insulin has no role in managing hemolysis, liver injury, or thrombocytopenia.

Choice C:

Encouraging ambulation is contraindicated due to bleeding risk and potential for vascular instability. Patients may have low platelets and be at risk for falls, hemorrhage, or worsening symptoms. Bed rest with close monitoring is preferred.

Choice D:

Restricting fluid intake helps prevent pulmonary edema, a complication of HELLP due to capillary leak and reduced oncotic pressure. Fluid overload worsens respiratory distress and increases maternal morbidity.

Choice E:

Monitoring liver function tests is essential because hepatic injury is a core feature. AST and ALT levels >70 IU/L indicate hepatocellular damage. Rising values may signal impending hepatic rupture or worsening inflammation.

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Practice Exercise 5

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