PROM and PPROM > Maternal & Newborn
Exam Review
Summary
Total Questions : 17
Showing 17 questions, Sign in for moreA nurse is teaching a pregnant woman who is at risk for pre-term labor.
Which of the following activities should the nurse instruct the woman to avoid?
Explanation
Sexual intercourse can trigger uterine contractions and increase the risk of preterm labor.
The nurse should instruct the woman to avoid sexual intercourse if she is at risk for preterm labor.
Choice A is wrong because drinking water is important for hydration and preventing dehydration, which can also cause uterine contractions.
Choice B is wrong because taking prenatal vitamins is essential for providing adequate nutrition and preventing deficiencies that can affect fetal development.
Choice D is wrong because performing fetal kick counts is a way of monitoring fetal well-being and detecting any signs of distress or reduced movement.
The nurse should encourage the woman to perform fetal kick counts regularly and report any concerns to her health care provider.
A nurse is providing discharge instructions to a client who had pre-term labor and was prescribed oral nifedipine.
Which of the following statements by the client indicates an understanding of the teaching?
Explanation
Nifedipine is a calcium channel blocker that lowers blood pressure by relaxing the blood vessels.It can cause dizziness and orthostatic hypotension (a drop in blood pressure when standing up), so the client should avoid getting up suddenly from a lying or sitting position.
Choice A is wrong because grapefruit juice can increase the level of nifedipine in the blood and cause side effects such as headache, flushing, and swelling.
The client should avoid grapefruit and grapefruit juice while taking nifedipine.
Choice C is wrong because nifedipine does not affect the heart rate directly.
The client does not need to check the pulse before taking nifedipine, but should monitor the blood pressure regularly.
Choice D is wrong because nifedipine is prescribed to prevent pre-term labor by relaxing the uterine muscles.
The client should not stop taking nifedipine if contractions occur, but should contact the health care provider for further instructions.Stopping nifedipine suddenly can cause a rebound increase in blood pressure and chest pain.
A nurse is evaluating the effectiveness of antibiotic therapy for a client who has PPROM at 28 weeks of gestation.
Which of the following findings indicates a positive outcome?
Explanation
Increased amniotic fluid index indicates a positive outcome of antibiotic therapy for a client who has PPROM at 28 weeks of gestation.Antibiotics are used to prevent or treat infection and prolong pregnancy in women with PPROM.Infection can cause oligohydramnios (low amniotic fluid) which can lead to fetal complications such as cord compression, pulmonary hypoplasia and limb deformities.
Therefore, an increased amniotic fluid index suggests that the infection has been reduced or resolved and the risk of preterm birth has been lowered.
Normal ranges for amniotic fluid index are 5 to 25 cm.Normal ranges for maternal pulse rate are 60 to 100 beats per minute.Normal ranges for maternal leukocyte count are 4.5 to 11 x 10^9/L.
A nurse is providing discharge instructions to a client who has PPROM at 30 weeks of gestation and is on home bed rest.
Which of the following instructions should the nurse include?
Explanation
The nurse should include all of these instructions for a client who has PPROM at 30 weeks of gestation and is on home bed rest.
A nurse is preparing to administer betamethasone to a client who has PPROM at 26 weeks of gestation.
Which of the following statements by the nurse is appropriate?
Explanation
Betamethasone is a corticosteroid that is given to women who have PPROM (preterm prelabor rupture of membranes) at 24 to 36 weeks of gestation to reduce the risk of neonatal respiratory distress syndrome and other complications.It is given as two doses of 12 mg intramuscularly, 24 hours apart.
A nurse is caring for a client who has PPROM at 32 weeks of gestation and is receiving antibiotics prophylactically.
The nurse should monitor the client for which of the following signs of infection?
Explanation
This is because PPROM increases the risk of infection for both the mother and the baby, and infection can cause fetal tachycardia, maternal leukocytosis, and increased vaginal discharge.
Normal ranges for fetal heart rate are 110 to 160 beats per minute.
Normal ranges for maternal white blood cells are 4,500 to 11,000/mm3.
Normal ranges for vaginal discharge vary depending on the stage of pregnancy and other factors.
A nurse is caring for a client who has PPROM at 30 weeks of gestation and is receiving corticosteroids to enhance fetal lung maturity.
The nurse should explain to the client that the corticosteroids will have which of the following effects on the fetus?
Explanation
Corticosteroids have multiple effects on the fetus, including:
• Decreasing the risk of respiratory distress syndrome (RDS) by increasing the production of surfactant, a substance that helps the lungs expand and prevents them from collapsing.
• Reducing the incidence of intraventricular hemorrhage (IVH), a type of bleeding in the brain that can cause brain damage or death.
• Reducing the risk of necrotizing enterocolitis (NEC), a serious intestinal infection that can cause tissue death and perforation.
Normal ranges for gestational age are 37 to 42 weeks.
Normal ranges for fetal weight are 2.5 to 4.5 kg.
Normal ranges for fetal heart rate are 110 to 160 beats per minute.
Normal ranges for amniotic fluid index are 5 to 25 cm.
A nurse is caring for a client who has PPROM at 26 weeks of gestation and is on bed rest.
The nurse should instruct the client to report which of the following symptoms immediately?
Explanation
The nurse should instruct the client to report any symptoms of contractions, bleeding, or fever immediately, as they may indicate complications of PPROM such as preterm labor, placental abruption, or chorioamnionitis.
PPROM is the rupture of membranes before 37 weeks of gestation.
It occurs in 3% of pregnancies and is the leading cause of preterm delivery.It can lead to serious complications for both the mother and the fetus.PPROM at 26 weeks of gestation is considered extreme PPROM and has a high risk of neonatal morbidity and mortality.The management of PPROM depends on the gestational age, maternal and fetal condition, and availability of neonatal care.The client with PPROM at 26 weeks of gestation should be on bed rest and receive antibiotics, corticosteroids, and magnesium sulfate to prolong latency, reduce neonatal complications, and prevent cerebral palsy.
A nurse is caring for a client who is at 26 weeks of gestation and has PPROM.
Which of the following medications should the nurse expect to administer to the client? (Select all that apply.)
Explanation
Betamethasone, magnesium sulfate and ampicillin are medications that can be given to a client who has PPROM.
• Betamethasone is a corticosteroid that can help the baby’s lungs mature faster and reduce the risk of respiratory distress syndrome.It is usually given between 24 and 34 weeks of gestation.
• Magnesium sulfate is a tocolytic that can prevent preterm labor and reduce the risk of intraventricular hemorrhage and cerebral palsy in the baby.It is usually given for 24 to 48 hours after PPROM.
• Ampicillin is an antibiotic that can prevent or treat infection in the amniotic fluid, which is a common complication of PPROM.It can also prolong the latency period (the time between PPROM and delivery) and improve neonatal outcomes.
Normal ranges for gestational age are:
• 37 to 42 weeks for term pregnancy
• 34 to 36 weeks for late preterm pregnancy
• 32 to 33 weeks for moderate preterm pregnancy
• 28 to 31 weeks for very preterm pregnancy
• Less than 28 weeks for extremely preterm pregnancy
A nurse is teaching a client who is at 30 weeks of gestation and has PROM about the signs and symptoms of infection.
Which of the following should the nurse include in the teaching? (Select all that apply.)
Explanation
These are signs and symptoms of infection that can occur after PROM (prelabor rupture of membranes), which is the leakage of amniotic fluid before labor begins.Infection can be very dangerous for both the mother and the baby.
Normal ranges for gestational age are 37 to 42 weeks for term pregnancy and less than 37 weeks for preterm pregnancy.Normal ranges for fetal heart rate are 110 to 160 beats per minute.
A nurse is evaluating the understanding of a client who is at 32 weeks of gestation and has PPROM after providing discharge instructions.
Which of the following statements by the client indicates a need for further teaching?
Explanation
The client should not use a tampon if they have any bleeding because it can increase the risk of infection.
A tampon can also interfere with the assessment of the amount and color of the bleeding.
A nurse is caring for a client with PROM who is receiving magnesium sulfate as a tocolytic agent.
Which of the following assessments should the nurse perform to monitor for magnesium toxicity?
Explanation
The nurse should perform all of the assessments listed to monitor for magnesium toxicity.
Magnesium sulfate is a drug that is given to prevent preterm labor by relaxing the uterine muscle.
However, it can also cause serious side effects such as weakness, low blood pressure, respiratory paralysis, and cardiac problems if the level of magnesium in the blood is too high.
The normal level of magnesium in the blood is about 1.5-2.5 mEq/L.Symptoms of toxicity may appear when the level reaches 4 mEq/L or higher.
A nurse is caring for a client with PPROM who is experiencing uterine contractions and signs of chorioamnionitis.
The nurse anticipates that the health care provider will order which of the following interventions?
Explanation
chorioamnionitis is a serious infection of the placental tissues that can cause fetal and maternal morbidity and mortality.The best management is to deliver the baby as soon as possible to prevent further complications.
Normal ranges for maternal blood C-reactive protein (CRP), procalcitonin and interleukin 6 (IL6) are:
• CRP: <10 mg/L
• Procalcitonin: <0.5 ng/mL
• IL6: <5 pg/mL
These markers may be elevated in chorioamnionitis, but they have low sensitivity and specificity for diagnosis.
A nurse is assessing a client with PROM who is at 37 weeks of gestation.
The nurse notes that the client has a foul-smelling vaginal discharge and a temperature of 38.2°C (100.8°F).
The nurse recognizes these findings as indicative of:
Explanation
Chorioamnionitis is an infection of the membranes containing the fetus and the amniotic fluid.It can occur when the membranes rupture before labor, especially if the rupture is prolonged or preterm.Chorioamnionitis can cause fever, foul-smelling vaginal discharge, abdominal pain, and fetal tachycardia.
Normal ranges for temperature are 36.5°C to 37.5°C (97.7°F to 99.5°F) and for fetal heart rate are 110 to 160 beats per minute.
A nurse is caring for a client who is at 26 weeks of gestation and has a diagnosis of PPROM.
Which of the following findings should the nurse report to the provider? (Select all that apply.).
Explanation
A temperature of 37.2°C (99°F) and uterine tenderness are signs of infection, which is a serious complication of PPROM.The normal temperature range during pregnancy is 36.4°C to 37.6°C (97.6°F to 99.6°F) orally.Uterine tenderness can indicate chorioamnionitis, which is an inflammation of the fetal membranes due to a bacterial infection.
A nurse is providing discharge instructions to a client who experienced PROM at 20 weeks of gestation and is on home bed rest.
Which of the following instructions should the nurse include?
Explanation
Drinking at least 2 L of fluids daily can help prevent dehydration and infection, which are possible complications of PROM (premature rupture of membranes).
Fluid intake also helps maintain amniotic fluid volume and fetal well-being.
A nurse is reviewing the laboratory results of a client who has PPROM at 30 weeks of gestation.
The nurse should expect to see which of the following values for the lecithin/sphingomyelin (L/S) ratio in the amniotic fluid?
Explanation
This value indicates a mature lecithin/sphingomyelin (L/S) ratio in the amniotic fluid, which reflects the fetal lung maturity and the low risk of respiratory distress syndrome (RDS) after birth.The L/S ratio is a test that measures the amount of lecithin and sphingomyelin, two types of phospholipids that are important for the formation of surfactant, a substance that prevents the lungs from collapsing.Lecithin increases and sphingomyelin stays constant as the fetus matures, so a higher L/S ratio indicates more surfactant and more lung development.A ratio of greater than 2:1 or 2.5:1 is 98% predictive of fetal lung maturity in most assays.
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