Health Promotion and Maintenance
66. A client, who is 19 years old, gravida 1, para 0, is admitted to labor and delivery with HELLP syndrome at 28 weeks' gestation. A nurse knows that management for her condition should include: Select all that apply.
. Administration of corticosteroid.
. Administration of an IV fluid bolus.
. Liver function tests.
. Administration of tocolytics.
. Bedrest in the left lateral position.
Test-Taking Tip
The key for this question is HELLP syndrome. The fact that the client is preterm is important for administration of corticosteroids for fetal lung maturity. Do not get distracted by the early gestation for treatment and eliminate the answer that refers to tocolytics (Answer 4).
Content Area: Maternity, Antepartum; Integrated Process: Nursing Process, Implementation; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Physiological Adaptation/Alterations in Body Systems
Health Promotion and Maintenance
. . .
Answer 1 is correct because the client who is 28 weeks' gestation with HELLP syndrome will most likely have to be delivered before reaching full-term gestation. Administration of corticosteroid to help mature the fetal lungs would be an appropriate part of management for this client. Answer 2 is incorrect because an IV fluid bolus is not an appropriate management for a client with increased blood pressure in HELLP syndrome. A fluid bolus can lead to fluid overload and increase third spacing of fluid, with possible pulmonary edema. Answer 3 is correct because elevated liver function tests are a part of the HELLP syndrome; following serial liver function tests will be a part of the management of this client's condition. Worsening liver function would be an indicator for early delivery. Answer 4 is incorrect because this client is admitted for HELLP, not preterm labor. Although she is preterm, tocolytics are not appropriate management for HELLP syndrome. Delivery is the only treatment for HELLP syndrome. Answer 5 is correct because bedrest in the left lateral position would be a part of the management to decrease blood pressure in this client.