A nurse is conducting an assessment of a woman who has experienced PROM. Which amniotic fluid finding would lead the nurse to suspect infection as the cause of a client's PROM?

ferning

yellow-green fluid

foul odor

blue color on Nitrazine testing

Answer and Explanation

The Correct Answer is C

A. Ferning is a test to detect ferning patterns in amniotic fluid under a microscope. A positive result indicates the presence of amniotic fluid but does not suggest infection.

B. Yellow-green fluid may suggest meconium-stained amniotic fluid, which is often associated with fetal distress, but it does not directly indicate infection. However, it can increase the risk of infection if the meconium is aspirated by the baby.

C. Foul odor is a key sign that infection may be present, particularly in the case of chorioamnionitis, an infection of the fetal membranes. A foul odor in the amniotic fluid suggests the presence of bacteria and should raise concern for infection, requiring prompt intervention.

D. Blue color on Nitrazine testing indicates that the amniotic fluid is alkaline, which is expected and normal, as amniotic fluid typically has a pH of 7-7.5. This test is used to confirm the rupture of membranes, not infection.

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Correct Answer is D

Explanation

A. Clear liquid diet may be appropriate later in treatment once symptoms improve, but it is not typically initiated immediately in a client with severe hyperemesis gravidarum, especially if they are unable to keep any fluids down.

B. Administration of labetalol is used to treat hypertension, particularly in preeclampsia, and is not related to the treatment of hyperemesis gravidarum.

C. Small frequent meals are part of long-term management or mild cases, but for severe hyperemesis gravidarum requiring hospitalization, oral intake is usually withheld initially.

D. Nothing by mouth (NPO) is correct. In severe hyperemesis gravidarum, the client is often kept NPO to rest the gastrointestinal tract and prevent further vomiting. Intravenous (IV) fluids, electrolytes, and sometimes antiemetic medications are administered to manage dehydration and nutritional deficits before gradually resuming oral intake.

A. fluid replacement B. birth of the fetus C. oxygenation D. control of hypertension

Correct Answer is C

Explanation

A. Fluid replacement is important for maintaining maternal and fetal circulation, but it is not the priority immediately following a seizure. Oxygenation and stabilizing the mother’s condition are more critical in the acute phase.

B. Birth of the fetus may become necessary if the mother’s condition worsens, but the immediate priority is stabilizing the mother and ensuring proper oxygenation to prevent further complications for both the mother and fetus.

C. Oxygenation is the priority intervention after a seizure in eclampsia. Seizures can lead to a decrease in oxygen levels, and ensuring adequate oxygenation is crucial for both the mother and fetus. The nurse should administer oxygen to support breathing and prevent hypoxia.

D. Control of hypertension is essential in managing eclampsia, but the immediate focus should be on stabilizing the mother post-seizure, which includes ensuring adequate oxygenation first. Once stabilized, antihypertensive medications can be administered as necessary.

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A nurse is conducting an assessment of a woman who has experienced PROM. Which amniotic fluid finding would lead the nurse to suspect infection as the cause of a client's PROM?

Nursing Test Bank

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Correct Answer is D

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Correct Answer is C

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