Coagulation profile.This is because HELLP syndrome is a pregnancy complication that involveshemolysis(breaking down of red blood cells),elevated liver enzymes(indicating liver injury) andlow platelet count(impairing blood clotting).A coagulation profile can help monitor these abnormalities and assess the risk of bleeding or clotting complications.

Choice A is wrong because blood glucose is not directly affected by HELLP syndrome, although it may be elevated in women with gestational diabetes or pre-existing diabetes.

Choice B is wrong because serum creatinine is a marker of kidney function, not liver function.However, kidney function may also be impaired in women with preeclampsia or eclampsia, which are associated with HELLP syndrome.

Choice D is wrong because thyroid function is not related to HELLP syndrome.Thyroid disorders may occur in pregnancy, but they have different symptoms and causes.

Hepatic rupture.The client with HELLP syndrome is experiencing severe epigastric pain and nausea due to liver damage caused by hemolysis, elevated liver enzymes and low platelets.Hepatic rupture is a life-threatening complication of HELLP syndrome that can cause bleeding and shock.

Choice B.Pancreatitis is wrong because it is not a common complication of HELLP syndrome and it usually causes more diffuse abdominal pain rather than localized epigastric pain.

Choice C.Gastric ulcer is wrong because it is not associated with HELLP syndrome and it does not explain the other symptoms such as hemolysis, elevated liver enzymes and low platelets.

Choice D.Cholecystitis is wrong because it is not related to HELLP syndrome and it usually causes right upper quadrant pain rather than epigastric pain.

Normal ranges for liver enzymes are AST < 40 IU/L and ALT < 56 IU/L.Normal range for platelet count is 150-400 x 10⁹/L.

“I will resume my oral contraceptive pills as soon as possible.”

This statement indicates a need for further teaching because oral contraceptive pills are not recommended for women who had HELLP syndrome during pregnancy.Oral contraceptive pills can increase the risk of blood clots and high blood pressure, which can be dangerous for women with a history of HELLP syndrome.

Women who had HELLP syndrome should consult their provider about alternative methods of contraception that are safer for them.

The other statements are correct and do not indicate a need for further teaching:

• A.“I will need to have regular blood pressure checks for a few weeks.” This statement is correct because women who had HELLP syndrome are at risk of developing high blood pressure or preeclampsia after delivery and need to monitor their blood pressure regularly.

• B.“I will avoid taking any nonsteroidal anti-inflammatory drugs (NSAIDs).” This statement is correct because NSAIDs can interfere with platelet function and increase the risk of bleeding, which can be harmful for women who had HELLP syndrome.

• D.“I will report any signs of bleeding or infection to my provider.” This statement is correct because women who had HELLP syndrome are at risk of developing complications such as hemorrhage, infection, liver rupture, or stroke and need to seek medical attention if they notice any signs of bleeding or infection.

Normal ranges:

• Blood pressure: less than 140/90 mmHg

• Platelet count: 150,000 to 450,000 per microliter of blood

• Liver enzymes: AST (aspartate aminotransferase) less than 40 U/L; ALT (alanine aminotransferase) less than 40 U/L

• Hemoglobin: 12 to 16 g/dL for women

The correct answer is choice A, B, C and D. Here is why:

• Choice A is correct becausemonitoring the client’s deep tendon reflexesis a way to assess the client’s neuromuscular status and the risk of magnesium toxicity.Magnesium sulfate can cause muscle weakness and decreased reflexes.

• Choice B is correct becausechecking the client’s urine output every houris a way to monitor the client’s renal function and fluid balance.Magnesium sulfate is excreted by the kidneys and can cause oliguria and fluid overload.

• Choice C is correct becauseadministering calcium gluconate as an antidote if neededis a way to treat magnesium toxicity.Calcium gluconate reverses the effects of magnesium sulfate on the neuromuscular and cardiovascular systems.

• Choice D is correct becausekeeping a bag of 0.9% sodium chloride solution at the bedsideis a way to prepare for possible complications of magnesium sulfate therapy such as hypotension, pulmonary edema, or cardiac arrest.Normal saline can help restore blood pressure and fluid balance.

• Choice E is wrong becauseflushing the IV line with heparin before and after infusionis not necessary or recommended for magnesium sulfate administration.Heparin is an anticoagulant that can increase the risk of bleeding and is not compatible with magnesium sulfate.

HELLP syndrome can occur before or after delivery.

Explanation:

• HELLP syndrome is a rare pregnancy complication that is a type of preeclampsia.It stands for hemolysis (breaking down of red blood cells), elevated liver enzymes (indicating liver damage), and low platelet count (affecting blood clotting).

• HELLP syndrome usually occurs during the third trimester of pregnancy, but it can also develop in the first week after childbirth (postpartum preeclampsia).

• The other statements are wrong because:

➤ B.HELLP syndrome is not caused by a bacterial infection, but by unknown factors that may involve abnormal placental development.

➤ C.HELLP syndrome cannot be prevented by taking folic acid supplements, but by early diagnosis and treatment of preeclampsia.

➤

D. HELLP syndrome is treated with corticosteroids and antihypertensives, but only as supportive measures to manage the symptoms and complications.The definitive treatment is delivery of the baby as soon as possible.

• Normal ranges for some of the tests used to diagnose HELLP syndrome are:

➤ Lactate dehydrogenase (LDH): 140 to 280 U/L

➤ Aspartate transaminase (AST): 10 to 40 U/L

➤ Platelet count: 150 to 450 x 10^9/L