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 A

Explanation

A. "This is meconium stool and is normal for a newborn." is the correct and most appropriate response. Meconium is the newborn’s first stool, typically passed within the first 24 to 48 hours of life. It is black, tarry, and sticky in appearance and consists of materials the baby ingested while in the womb, such as amniotic fluid, mucus, and cells. It is completely normal and expected.

B. "You probably took iron during your pregnancy and that is what causes this type of stool." is incorrect. While iron supplements can darken adult stools, meconium is unrelated to maternal iron intake and is a normal physiological occurrence in all newborns.

C. “This is unusual, and I need to report this to your pediatrician." is incorrect and would be alarming to the parent unnecessarily. This is a normal finding, not something requiring physician notification.

D. "I'll take a sample and check it for possible bleeding" is also inappropriate unless there are other signs of concern (e.g., blood in stool later on). Meconium is not indicative of bleeding and does not warrant testing under normal circumstances.

A. Increase in dietary protein B. Schedule a repeat Glucose challenge test (GCT) C. Restrict carbohydrate intake D. Return for a fasting 3-hour glucose tolerance test (GTT)

Correct Answer is D

Explanation

A. Increase in dietary protein is not the appropriate response based on the results of the glucose challenge test. Protein intake may be adjusted for other health reasons but is not typically a first-line intervention after an abnormal GCT result.

B. Schedule a repeat Glucose Challenge Test (GCT) is not typically the next step. If the initial GCT is abnormal (usually a result >130-140 mg/dL), a repeat test is not recommended. Instead, a 3-hour glucose tolerance test (GTT) is used to confirm or rule out gestational diabetes.

C. Restrict carbohydrate intake might be part of managing gestational diabetes if it is diagnosed, but it is not the immediate next step after an abnormal GCT result. The focus is on further testing with a 3-hour GTT to confirm gestational diabetes.

D. Return for a fasting 3-hour glucose tolerance test (GTT) is the correct next step. If a client’s GCT result is ≥130-140 mg/dL, a 3-hour GTT is typically scheduled. The 3-hour GTT is a more comprehensive test that involves fasting and measuring blood glucose levels after consuming a larger dose of glucose (100 g). This test is used to diagnose gestational diabetes.

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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?

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