Susan Wilson 1 Hesi Case study OB with complete solution
You also review Susan's lab work, recalling that pregnancy tests on urine or blood are
determined to be positive based on the presence of a particular hormone. This biologic
marker of pregnancy is:
A. human chorionic gonadotropin
B. estrogen
C. progesterone
D. follicle-stimulating hormone
A. human chorionic gonadotropin
Human chorionic gonadotropin (HCG), produced by the trophoblast cells of the placenta
soon after implantation of a fertilized ovum, is a biologic marker of pregnancy. It can be
detected in maternal serum and urine as early as six days after conception, depending
on the test performed. It reaches its maximum level in 50-70 days. The presence of
HCG in Susan's blood is considered a probable sign of pregnancy. Positive pregnancy
tests can also occur if the client has certain tumors which produce HCG. Progesterone
is not a biological marker of pregnancy, but increases in progesterone levels are critical
for the maintenance of a pregnancy.
During Susan's pelvic examination, a bluish discoloration of the cervix and vaginal
mucosa is observed. This is a sign of pregnancy and is documented as
_____________.
Chadwick's sign
Which of the following is considered a positive sign of pregnancy that could be present
at this point in Susan's pregnancy (eight weeks gestation)?
A. Fetal cardiac activity or body movement noted on ultrasound
B. Palpation of fetal movements by an examiner
C. Ballottement noted on vaginal examination
D. Uterine souffle auscultated with Doppler
A. Fetal cardiac activity or body movement noted on ultrasound
Ultrasonography is a noninvasive technique that can detect the presence of fetal
cardiac activity or body movement as early as 6-7 weeks gestation. Detection of fetal
cardiac activity or movement by ultrasound would be a positive sign of pregnancy. At
eight weeks gestation, fetal activity could be demonstrated on ultrasound.
Which of the following suggestions are appropriately made to Susan to help alleviate
her symptoms?
Select all that apply (there are 2 correct answers).
A. Eat a large breakfast
Eating a large meal in the morning would distend Susan's stomach and increase the
likelihood of nausea and vomiting. Eating a large meal in the morning should be
avoided.
, B. Eat small frequent meals throughout the day Correct
Small, frequent meals are recommended for the pregnant woman who is experiencing
nausea and vomiting. An empty stomach or one that is overloaded would increase the
likelihood of nausea and vomiting.
C. Eat dry toast or crackers before getting out of bed Correct
Eating a dry carbohydrate, such as toast or crackers, before getting out of bed in the
morning, often helps to prevent the nausea associated with "morning sickness." If
nausea is present before rising, it is advisable to remain in bed after eating a dry
carbohydrate until the feeling of nausea subsides.
D. Drink plenty of fluids when nausea occurs
Increasing fluids would not be useful in alleviating nausea. Fluids can distend the
stomach, increasing nausea. Small amounts of fluid, alternated hourly with dry
carbohydrates, may be helpful in alleviating nausea.
B. Eat small frequent meals throughout the day
C. Eat dry toast or crackers before getting out of bed
Small, frequent meals are recommended for the pregnant woman who is experiencing
nausea and vomiting. An empty stomach or one that is overloaded would increase the
likelihood of nausea and vomiting.
Eating a dry carbohydrate, such as toast or crackers, before getting out of bed in the
morning, often helps to prevent the nausea associated with "morning sickness." If
nausea is present before rising, it is advisable to remain in bed after eating a dry
carbohydrate until the feeling of nausea subsides.
Susan asks you, "How much is too much vomiting?" You advise Susan to call the clinic
if she experiences which of the following?
Select all that apply (there are 3 correct answers).
A. She urinates less frequently than usual, and her urine becomes darker in color
B. Her palms become reddened and itch
C. She vomits blood or her throat becomes sore from vomiting
D. She vomits everything she eats or drinks in a 24-hour period
A. She urinates less frequently than usual, and her urine becomes darker in color
C. She vomits blood or her throat becomes sore from vomiting
D. She vomits everything she eats or drinks in a 24-hour period
With excessive vomiting, Susan could become dehydrated. With dehydration, the body
would retain fluid as a compensatory measure, and urine output would decrease. Urine
would also become more concentrated, and darker in color. It is appropriate that Susan
be advised to report signs of dehydration.
Vomiting blood and a very sore throat are significant. They could be the result of a tear
in the mucosa of the esophagus, secondary to retching (dry heaves). Susan should
seek medical attention immediately if these occur.
You also review Susan's lab work, recalling that pregnancy tests on urine or blood are
determined to be positive based on the presence of a particular hormone. This biologic
marker of pregnancy is:
A. human chorionic gonadotropin
B. estrogen
C. progesterone
D. follicle-stimulating hormone
A. human chorionic gonadotropin
Human chorionic gonadotropin (HCG), produced by the trophoblast cells of the placenta
soon after implantation of a fertilized ovum, is a biologic marker of pregnancy. It can be
detected in maternal serum and urine as early as six days after conception, depending
on the test performed. It reaches its maximum level in 50-70 days. The presence of
HCG in Susan's blood is considered a probable sign of pregnancy. Positive pregnancy
tests can also occur if the client has certain tumors which produce HCG. Progesterone
is not a biological marker of pregnancy, but increases in progesterone levels are critical
for the maintenance of a pregnancy.
During Susan's pelvic examination, a bluish discoloration of the cervix and vaginal
mucosa is observed. This is a sign of pregnancy and is documented as
_____________.
Chadwick's sign
Which of the following is considered a positive sign of pregnancy that could be present
at this point in Susan's pregnancy (eight weeks gestation)?
A. Fetal cardiac activity or body movement noted on ultrasound
B. Palpation of fetal movements by an examiner
C. Ballottement noted on vaginal examination
D. Uterine souffle auscultated with Doppler
A. Fetal cardiac activity or body movement noted on ultrasound
Ultrasonography is a noninvasive technique that can detect the presence of fetal
cardiac activity or body movement as early as 6-7 weeks gestation. Detection of fetal
cardiac activity or movement by ultrasound would be a positive sign of pregnancy. At
eight weeks gestation, fetal activity could be demonstrated on ultrasound.
Which of the following suggestions are appropriately made to Susan to help alleviate
her symptoms?
Select all that apply (there are 2 correct answers).
A. Eat a large breakfast
Eating a large meal in the morning would distend Susan's stomach and increase the
likelihood of nausea and vomiting. Eating a large meal in the morning should be
avoided.
, B. Eat small frequent meals throughout the day Correct
Small, frequent meals are recommended for the pregnant woman who is experiencing
nausea and vomiting. An empty stomach or one that is overloaded would increase the
likelihood of nausea and vomiting.
C. Eat dry toast or crackers before getting out of bed Correct
Eating a dry carbohydrate, such as toast or crackers, before getting out of bed in the
morning, often helps to prevent the nausea associated with "morning sickness." If
nausea is present before rising, it is advisable to remain in bed after eating a dry
carbohydrate until the feeling of nausea subsides.
D. Drink plenty of fluids when nausea occurs
Increasing fluids would not be useful in alleviating nausea. Fluids can distend the
stomach, increasing nausea. Small amounts of fluid, alternated hourly with dry
carbohydrates, may be helpful in alleviating nausea.
B. Eat small frequent meals throughout the day
C. Eat dry toast or crackers before getting out of bed
Small, frequent meals are recommended for the pregnant woman who is experiencing
nausea and vomiting. An empty stomach or one that is overloaded would increase the
likelihood of nausea and vomiting.
Eating a dry carbohydrate, such as toast or crackers, before getting out of bed in the
morning, often helps to prevent the nausea associated with "morning sickness." If
nausea is present before rising, it is advisable to remain in bed after eating a dry
carbohydrate until the feeling of nausea subsides.
Susan asks you, "How much is too much vomiting?" You advise Susan to call the clinic
if she experiences which of the following?
Select all that apply (there are 3 correct answers).
A. She urinates less frequently than usual, and her urine becomes darker in color
B. Her palms become reddened and itch
C. She vomits blood or her throat becomes sore from vomiting
D. She vomits everything she eats or drinks in a 24-hour period
A. She urinates less frequently than usual, and her urine becomes darker in color
C. She vomits blood or her throat becomes sore from vomiting
D. She vomits everything she eats or drinks in a 24-hour period
With excessive vomiting, Susan could become dehydrated. With dehydration, the body
would retain fluid as a compensatory measure, and urine output would decrease. Urine
would also become more concentrated, and darker in color. It is appropriate that Susan
be advised to report signs of dehydration.
Vomiting blood and a very sore throat are significant. They could be the result of a tear
in the mucosa of the esophagus, secondary to retching (dry heaves). Susan should
seek medical attention immediately if these occur.
