(Part 2)
H-mole
H-mole
(Penalty: -40 points)
List 3 ways H-Mole is known as.
A: Hydatidiform Mole, Gestational Trophoblastic Disease, Molar Pregnancy
(Penalty: -40 points)
Patient Alex is 25 years old, 34 weeks pregnant, G2P1. She is currently at a prenatal check up with vital signs of BP: 160/110, low urine output and a chief complaint of seizures. What is the potential diagnosis of this patient?
Ans: Eclampsia
R: Eclampsia is a severe form of pre-eclampsia characterized by a blood pressure greater than 160/110 and with the presence of seizures during pregnancy
(Penalty: -60 points)
Which of the following interventions should be prioritized for a patient experiencing eclamptic seizure?
A. Time seizure
B. Restrain the patient to prevent injury
C. Prepare the patient for emergency C-section
Ans: A.
R: Timing seizure aids in determining the severity of the seizure as a seizure lasting for more than 5 minutes, or a continuous seizure without pauses in between, indicates inadequate amount of oxygen in the blood, hypoxia, that may lead to brain damage.
(Penalty: -40 points)
Which of the following best describes Gestational Diabetes Mellitus?
a. A condition where blood glucose levels drop significantly during pregnancy
b. A temporary condition where glucose intolerance develops during pregnancy
c. A form of Type 1 diabetes that occurs only in pregnant women
d. A genetic disorder affecting insulin receptors
Ans: b. A temporary condition where glucose intolerance develops during pregnancy
R: GDM is characterized by glucose intolerance that begins or is first detected during pregnancy due to insulin resistance caused by hormonal changes.
Which hormone is primarily responsible for insulin resistance in pregnancy?
a. Progesterone
b. Human placental lactogen (hPL)
c. Estrogen
d. Oxytocin
Ans: b. Human placental lactogen (hPL)
R: hPL increases insulin resistance to ensure adequate glucose supply for the fetus. However, excessive resistance leads to GDM.
(Penalty: -80 points)
What is the surgical management of choice when treating H-mole?
A: Suction D&C(Dilation & Curettage)
R: Suction D&C is the procedure of choice for hydatidiform mole because it effectively removes molar tissue while reducing the risk of uterine perforation and excessive bleeding, ensuring a safer evacuation.
(Penalty: -100 points)
Which of the following best explains the pathophysiology of preeclampsia?
A. Excessive trophoblastic invasion leading to increased placental perfusion
B. Increased nitric oxide production causing systemic vasodilation
C. Defective trophoblastic invasion leading to endothelial dysfunction and vasoconstriction
D. Hypervolemia and increased cardiac output leading to hypertension
C. Defective trophoblastic invasion leading to endothelial dysfunction and vasoconstriction.
R: Preeclampsia is caused by abnormal trophoblastic invasion of the spiral arteries, leading to poor placental perfusion. This triggers endothelial dysfunction, increased release of vasoconstrictors (e.g., endothelin, thromboxane), reduced nitric oxide, and increased vascular permeability, resulting in hypertension, proteinuria, and organ dysfunction.
(Penalty: -120 points)
What are the 3 classic signs of pre-eclampsia
Answer: Hypertension, Edema, Proteinuria
R: This is the result of endothelial damage, vasospasm, and increased vascular permeability. Hypertension occurs due to increased vascular resistance, edema from fluid leakage into tissues, and proteinuria from glomerular endothelial damage.
A pregnant woman with GDM is at increased risk for which fetal complication?
a. Neural tube defects
b. Fetal macrosomia
c. Low birth weight
d. Congenital heart defects
Ans: b. Fetal macrosomia
R: Excess maternal glucose crosses the placenta, leading to increased fetal insulin production, which promotes excessive fetal growth (macrosomia).
Which diagnostic test is commonly used as an initial screening for GDM?
a. Fasting blood sugar (FBS)
b. Glycated hemoglobin (HbA1c)
c. Glucose challenge test (GCT)
d. Oral glucose tolerance test (OGTT)
Ans: c. Glucose challenge test (GCT)
R: GCT is a non-fasting test where a 50g glucose solution is given, and blood glucose is measured after 1 hour. If levels are ≥140 mg/dL, further testing is needed.
(Penalty: -170 points)
If the H-Mole is left untreated, what would be the likely complication?
A: The trophoblastic cells can metastasize and become malignant. This can cause choriocarcinoma and may migrate into the lungs.
(Penalty: -170 points)
A patient with eclampsia is experiencing seizures. What is the first line of treatment?
Answer: Magnesium Sulfate
(Penalty: -180 points)
What is the sign that suggests magnesium sulfate toxicity and what should be given in order to counteract this?
Ans: Loss of Deep tendon reflexes & Calcium Gluconate
R: Magnesium sulfate is an anticonvulsant that prevents seizures by being a CNS depressant, too much magnesium levels can lead to over-sedation of the nervous system leading to the loss of DTRs. Calcium gluconate counteracts the magnesium sulfate's effects by restoring neuromuscular excitability.
Which of the following is NOT a risk factor for developing GDM?
a. Obesity before pregnancy
b. Sedentary lifestyle
c. History of polycystic ovary syndrome (PCOS)
d. Low carbohydrate intake
Ans: d. Low carbohydrate intake
R: High carbohydrate and fat intake contribute to insulin resistance, while a low-carb diet is usually recommended for managing GDM.
Which of the following is the first-line treatment for most cases of GDM?
a. Insulin therapy
b. Metformin
c. Lifestyle modifications (diet and exercise)
d. Glyburide
Ans: c. Lifestyle modifications (diet and exercise)
R: Diet and exercise are the initial management strategies to control blood sugar. If glucose levels remain uncontrolled, insulin or oral agents may be used.
(Penalty: -280 points)
A patient with a diagnosis H-mole has done an ultrasound test. As a nurse, what do you expect for the prominent finding to be?
A: "Snowstorm" or "grape-like clusters"
R: The "snowstorm" or "grape-like cluster" appearance on ultrasound is caused by swollen, hydropic chorionic villi, which are characteristic of a complete molar pregnancy
(Penalty: -250 points)
Which of the following is NOT a predisposing factor of pre-eclampsia:
A. Antiphospholipid syndrome
B. Multiparity (> 5 pregnancies)
C. Women of color
D. Cystic fibrosis
Answer: D. Cystic Fibrosis
Rationale: Cystic Fibrosis does not inherently cause placental abnormalities. Its pathophysiology primarily affects the lungs, pancreas, and digestive system.
(Penalty: -290 points)
What diet should a nurse suggest for a patient with preeclampsia?
Ans: Low salt, Low fat diet
R: This is done to manage hypertension and fluid retention as excess sodium would cause fluid retention causing an increase in blood pressure. Low fat diet on the other hand can aid in preventing further endothelial damage due to the increased cholesterol further elevating blood pressure.
What are the 3P's in the context of the signs and symptoms of GDM?
Polyuria - Excessive urination
Polyphagia - Insatiable Hunger
Polydipsia - Increased Thirst
Which postpartum test is recommended for women who had GDM?
a. Random blood sugar (RBS)
b. Glycated hemoglobin (HbA1c)
c. 75g Oral Glucose Tolerance Test (OGTT) at 6-12 weeks postpartum
d. Fasting insulin test
Ans: c. 75g Oral Glucose Tolerance Test (OGTT) at 6-12 weeks postpartum
R: Women with GDM are at risk for Type 2 diabetes, so an OGTT is recommended postpartum to assess glucose tolerance.
(Penalty: REGRET!)
A patient with a history of a recently evacuated hydatidiform mole has persistently elevated beta-hCG levels. What is the nurse’s priority action?
A. Reassure the patient that hCG levels take months to normalize
B. Monitor for signs of choriocarcinoma and notify the physician
C. Advise the patient to try conceiving to regulate hormone levels
D. Encourage the patient to stop contraceptive use for better hormonal balance
Answer:
B. Monitor for signs of choriocarcinoma and notify the physician
Rationale:
Persistently elevated beta-hCG levels after a molar pregnancy evacuation may indicate gestational trophoblastic neoplasia (GTN), including choriocarcinoma, which requires prompt medical intervention. The nurse should monitor for metastasis, reinforce the need for hCG follow-up testing, and coordinate with the physician for further evaluation and possible chemotherapy.
(Penalty: -300 points)
Give at least 2 medications that are the first line of treatment and drug choice to treat elevated blood pressure in pre-eclamptic or eclamptic patients.
- Nifedipine, Labetalol, and Hydralazine.
(Penalty: -300 points)
What is the significance of the HELLP syndrome with pre-eclampsia?
A /w R:
HELLP syndrome is a complication of severe pre-eclampsia characterized by vast endothelial damage, elevated liver enzymes, activation of the coagulation cascade, and damaged RBCs. HELLP means "Hemolysis, Elevated Liver enzymes, Low Platelets," and this can lead to organ dysfunction, rapid deterioration, and life-threatening complications like DIC, liver rupture, and stroke.
Which statement is true regarding GDM and breastfeeding?
a. Breastfeeding is discouraged as it can worsen maternal glucose levels
b. Breastfeeding helps stabilize maternal blood glucose levels and reduces the risk of Type 2 diabetes
c. Breastfeeding increases the risk of neonatal hypoglycemia
d. Breastfeeding has no impact on glucose metabolism
Answer: b. Breastfeeding helps stabilize maternal blood glucose levels and reduces the risk of Type 2 diabetes
Breastfeeding is beneficial for mothers with gestational diabetes mellitus (GDM) as it helps regulate blood glucose levels postpartum and reduces the risk of developing Type 2 diabetes. It also supports neonatal glucose stability by providing a steady source of nutrition.
What neonatal complication can occur due to uncontrolled GDM?
a. Neonatal hypoglycemia
b. Hyperbilirubinemia
c. Respiratory distress syndrome
d. All of the above
Ans: d. All of the above
R: Infants born to mothers with uncontrolled GDM are at risk for neonatal hypoglycemia (due to high fetal insulin), hyperbilirubinemia, and respiratory distress syndrome.