# A nurse is assessing a pregnant client at 10 weeks gestation who presents with persistent nausea and vomiting. Which assessment finding would be most indicative of hyperemesis gravidarum? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542903 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is assessing a pregnant client at 10 weeks gestation who presents with persistent nausea and vomiting. Which assessment finding would be most indicative of hyperemesis gravidarum? A 26-year-old primigravida at 8 weeks gestation presents to the emergency department with complaints of severe nausea and vomiting that has persisted for the past 2 weeks. She reports being unable to keep food or fluids down and has lost 12 pounds since her last prenatal visit 3 weeks ago. The nurse needs to assess for signs of hyperemesis gravidarum. ## 보기 1. Nausea and vomiting occurring only in the morning hours 2. Occasional episodes of vomiting with mild dehydration 3. Nausea relieved by eating small, frequent meals 4. Weight loss exceeding 5% of pre-pregnancy weight with ketonuria **✔ 정답** **정답: 4** ## 해설 Weight loss >5% of pre-pregnancy weight with ketonuria is a key diagnostic criterion for hyperemesis gravidarum, indicating severe metabolic compromise. Other options describe milder or typical morning sickness. ## 심화 해설 Understanding Hyperemesis Gravidarum vs. Normal Nausea and Vomiting of Pregnancy The key to answering this question lies in differentiating the expected, albeit uncomfortable, nausea and vomiting of pregnancy (NVP) from the pathologic condition of hyperemesis gravidarum (HG). While NVP is common in the first trimester, HG represents a severe form that poses significant risks to both the pregnant individual and the fetus. Analyzing the Correct Answer (Option 4) The finding most indicative of hyperemesis gravidarum is weight loss exceeding 5% of pre-pregnancy weight with ketonuria. This option captures the two core clinical consequences that define the severity of HG: significant nutritional depletion and a metabolic shift toward starvation. The clinical criteria for HG, as highlighted in the literature, center on severe nausea and vomiting leading to dehydration, weight loss, and an inability to tolerate oral intake [1]. A weight loss of 12 pounds in 3 weeks for a patient in early gestation is a critical red flag that far exceeds the mild weight fluctuations sometimes seen with NVP. When the body is unable to utilize glucose from food due to persistent vomiting, it breaks down fat for energy, producing ketone bodies that spill into the urine (ketonuria). This objective finding provides concrete evidence of the metabolic starvation state that distinguishes HG from milder forms of pregnancy-related nausea [1,2]. Analyzing the Incorrect Options - Option 1: Nausea and vomiting occurring only in the morning hours describes the classic pattern of "morning sickness," or typical NVP. HG is not confined to a specific time of day; it is persistent and severe, leading to an inability to maintain adequate hydration or nutrition [1,3]. - Option 2: Occasional episodes of vomiting with mild dehydration do not meet the severity threshold for HG. The condition is defined by its substantial impact, including significant impairment of daily activities and a clinical picture of more than just mild dehydration [2,3]. The patient in the scenario has been unable to keep fluids down for two weeks, pointing to a more profound fluid deficit. - Option 3: Nausea relieved by eating small, frequent meals is a hallmark of mild to moderate NVP and a first-line management strategy for it. In HG, nausea is typically unrelenting, and patients cannot tolerate any oral intake, making dietary modifications ineffective as a sole intervention [1,4]. Pathophysiology and Clinical Implications The underlying etiology of HG is not fully understood, but its clinical consequences are well-documented and can become life-threatening. The severe, protracted vomiting initiates a cascade of complications. Profound fluid loss leads to hypovolemia and electrolyte imbalances, such as hyponatremia and hypokalemia, which can cause cardiac dysrhythmias. The case report of a patient with HG carrying twins illustrated a progression to severe hypovolemic shock, ionic disruption, and even acute renal failure due to prerenal azotemia from dehydration . Hematologic disturbances, including hemoconcentration from volume depletion, are also associated with the condition [2]. Therefore, a nurse’s assessment must focus on these systemic effects. Identifying a weight loss exceeding 5% of pre-pregnancy weight and the presence of ketonuria on a urine dipstick confirms that the patient has moved beyond simple NVP into a state of metabolic decompensation requiring urgent medical intervention, typically involving intravenous fluid replacement, electrolyte correction, and antiemetic therapy [1,4].References (research sources) - [1]Clinical characteristics, management and outcomes of hyperemesis gravidarum: a retrospective study in an Irish maternity hospital.Research articleDoherty J, Killeen SL, Sheehy L, McHale H, Curran S, Bennett M, Murphy S, O'Brien E. (2026) · DOI: 10.1007/s11845-025-04233-7 - [2]Prevalence of hyperemesis gravidarum and its associated electrolyte and hematologic disturbances in pregnant women.Research articleGhanem HB, Hammoudeh SM, Abulfaraj M, Elsherbini DMA, Hussein SE, Algader JI, Alanazi RM, Alshammari TY, Alruwaili AE, Alruwaili NB, El-Sherbiny M, Alshaikh ABA, Elshamy M, Abdelrahman MMA, Bahgat NA. (2026) · DOI: 10.3389/fmed.2026.1703120 ## 임상 시나리오 Clinical Guide: Assessing for Hyperemesis Gravidarum Defining the Condition Hyperemesis gravidarum (HG) is a pathologic condition distinct from typical nausea and vomiting of pregnancy (NVP). It is characterized by severe, persistent nausea and vomiting leading to dehydration, electrolyte imbalance, and nutritional deficiency. The diagnosis is clinical, based on the exclusion of other causes and the presence of hallmark features. Key Assessment Findings The most critical indicators differentiating HG from NVP are objective signs of starvation and significant volume depletion. The nurse should prioritize the following assessments: - **Weight Loss:** Documented loss of more than 5% of pre-pregnancy body weight is a defining criterion. A rapid loss, such as 12 pounds in 3 weeks, demands immediate attention. - **Ketonuria:** A urine dipstick positive for ketones provides concrete evidence of a catabolic starvation state where the body is metabolizing fat for fuel due to inadequate carbohydrate intake. - **Signs of Dehydration:** Assess for poor skin turgor, dry mucous membranes, orthostatic hypotension, tachycardia, and concentrated urine with elevated specific gravity. - **Electrolyte Imbalances:** Persistent vomiting leads to loss of hydrochloric acid, potentially causing hypokalemia, hyponatremia, and metabolic alkalosis. Monitor for muscle weakness, cardiac arrhythmias, and paresthesia. Nursing Interventions and Triage Once HG is suspected, the priority is stabilization. Initial interventions often begin in the emergency department or inpatient setting: - **NPO Status:** Place the patient on nothing-by-mouth status initially to rest the gastrointestinal tract. - **IV Fluid Resuscitation:** Administer isotonic intravenous fluids (e.g., normal saline or lactated Ringer's) with thiamine supplementation before dextrose to prevent Wernicke encephalopathy. - **Antiemetic Therapy:** Administer first-line antiemetics as ordered, such as doxylamine/pyridoxine, ondansetron, or metoclopramide, monitoring for extrapyramidal side effects. - **Strict Monitoring:** Maintain accurate intake and output records, daily weights, and serial monitoring of urine ketones and serum electrolytes. Patient Education and Follow-Up Educate the patient that HG is a treatable medical condition and not a normal part of pregnancy. Discuss the importance of gradual reintroduction of oral intake with bland, dry foods once vomiting subsides. Arrange for home health follow-up to monitor weight and hydration status, and provide clear return precautions for recurrence of severe symptoms. ## 핵심 개념 - **Hyperemesis Gravidarum** — A severe form of nausea and vomiting in pregnancy characterized by persistent vomiting, weight loss exceeding 5% of prepregnancy weight, dehydration, electrolyte imbalances, and ketonuria, requiring medical intervention. - **Ketonuria** — The presence of ketone bodies in the urine, indicating that the body is breaking down fat for energy due to inadequate carbohydrate intake or starvation, a key objective finding in hyperemesis gravidarum. - **Nausea and Vomiting of Pregnancy (NVP)** — Common 'morning sickness' typically occurring in the first trimester, characterized by nausea and occasional vomiting that does not result in significant weight loss, dehydration, or metabolic disturbance. ## 같은 주제 문제 - [A nurse is assessing a client at 8 weeks gestation who was admitted with hyperemesis gravi…](https://mymerci.kr/pages/nclex_q.php?qn_id=542902) - [A nurse is assessing a 28-year-old client at 10 weeks gestation who presents with severe n…](https://mymerci.kr/pages/nclex_q.php?qn_id=542904) - [A nurse is caring for a 25-year-old client at 12 weeks gestation who has been admitted wit…](https://mymerci.kr/pages/nclex_q.php?qn_id=542905) - [A nurse is caring for a pregnant client diagnosed with hyperemesis gravidarum. 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