A client with no prenatal care delivers a healthy male infant via ...

[haleyc112]

A client with no prenatal care delivers a healthy male infant via the vaginal route, with minimal blood loss. During the labor period, vital signs were normal. At birth, significant maternal hypertension is noted.
 
  When the client is questioned, she relates that there is history of heart disease in her family but that she has never been treated for hypertension. Blood pressure is treated in the hospital setting and the client is discharged. The client returns at her scheduled 6-week checkup and is found to be hypertensive. Which type of hypertension do you think the client is exhibiting?
 
  a. Pregnancy-induced hypertension (PIH)
  b. Gestational hypertension
  c. Preeclampsia superimposed on chronic hypertension
  d. Undiagnosed chronic hypertension

Question 2

A client who was pregnant had a spontaneous abortion at approximately 4 weeks' gestation. At the time of the miscarriage, it was thought that all products of conception were expelled.
 
  Two weeks later, the client presents at the clinic office complaining of crampy abdominal pain and a scant amount of serosanguineous vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs reveal a temperature of 100 F, with blood pressure of 100/60 mm Hg, irregular pulse 88 beats/min (bpm), and respirations, 20 breaths/min. Based on these assessment data, what does the nurse anticipate as a clinical diagnosis?
 
  a. Ectopic pregnancy
  b. Uterine infection
  c. Gestational trophoblastic disease
  d. Endometriosis

[JYan]

Answer to Question 1

ANS: D
Even though the client has no documented prenatal care or medical history, she does relate a family history that is positive for heart disease. Additionally, the client's blood pressure increased following birth and was treated in the hospital and resolved. Now the client appears at the 6-week checkup with hypertension. Typically, gestational hypertension resolves by the end of the 6-week postpartum period. The fact that this has not resolved is suspicious for undiagnosed chronic hypertension. There is no evidence to suggest that the client was preeclamptic prior to the birth.

Answer to Question 2

ANS: B
The client is exhibiting signs of uterine infection, with elevated temperature, vaginal discharge with odor, abdominal pain, and blood pressure and pulse manifesting as shock-trended vitals. Because the pregnancy test is negative, an undiagnosed ectopic pregnancy and gestational trophoblastic disease are ruled out. There is no supportive evidence to indicate a clinical diagnosis of endometriosis at this time; however, it is more likely that this is an infectious process that must be aggressively treated.