A nurse is performing a sterile speculum examination on a client with suspected PROM at 36 weeks of gestation.

The nurse observes a pool of clear fluid in the vagina.

What is the most appropriate action for the nurse to take next?

Perform a nitrazine test to confirm the presence of amniotic fluid.

Perform a digital vaginal examination to assess cervical dilation and effacement.

Perform a fern test to confirm the presence of amniotic fluid.

Perform an ultrasound to assess fetal position and amniotic fluid index.

Answer and Explanation

The Correct Answer is A

A nitrazine test is a conventional test that uses pH testing of leaked amniotic fluid. Amniotic fluid is alkaline and turns the nitrazine paper blue, while vaginal secretions are acidic and turn the paper yellow or green.

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Correct Answer is ["A","B","C"]

Explanation

The correct answer is choice A, B and C. These interventions are part of the preoperative care for a client who is undergoing an emergency cesarean birth due to umbilical cord prolapse.Umbilical cord prolapse is a medical emergency that occurs when the umbilical cord slips through the cervix and into the vagina before the baby, causing fetal hypoxia.

Choice D is wrong because performing a leopold maneuver to determine fetal position is not necessary in this situation, as the fetal presentation is already known and the priority is to deliver the baby as soon as possible.

Choice E is wrong because applying an external fetal monitor to assess fetal heart rate is not sufficient in this situation, as the cord compression may cause severe bradycardia or variable decelerations.The nurse should manually lift the presenting part and hold it off the prolapsed cord while preparing for cesarean delivery.

A. Corticosteroids can help prevent infection in the uterus and fetus. B. Corticosteroids can help reduce bleeding and placental abruption. C. Corticosteroids can help enhance fetal lung maturity and reduce neonatal complications. D. Corticosteroids can help inhibit uterine contractions and prolong pregnancy.

Correct Answer is C

Explanation

corticosteroids can stimulate the production of surfactant, a substance that prevents the collapse of the alveoli in the lungs, and reduce the risk of respiratory distress syndrome, intraventricular hemorrhage, and neonatal death.

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A nurse is performing a sterile speculum examination on a client with suspected PROM at 36 weeks of gestation. The nurse observes a pool of clear fluid in the vagina. What is the most appropriate action for the nurse to take next?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing a client for an emergency cesarean birth due to umbilical cord prolapse. Which of the following interventions should the nurse include in the preoperative care? (Select all that apply.).

Correct Answer is ["A","B","C"]

Explanation

A nurse is caring for a client with PPROM at 32 weeks of gestation. The client asks the nurse why she needs to take corticosteroids. The nurse’s best response is:

Correct Answer is C

Explanation

A nurse is educating a client with PPROM at 30 weeks of gestation who is being discharged home on bed rest with bathroom privileges. Which of the following instructions should the nurse include in the teaching plan? (Select all that apply.).

A nurse is performing a sterile speculum examination on a client with suspected PROM at 36 weeks of gestation. The nurse observes a pool of clear fluid in the vagina. What is the most appropriate action for the nurse to take next?

A nurse is monitoring a client with PROM at 34 weeks of gestation who is receiving tocolytic therapy. Which of the following findings would indicate a potential adverse effect of the medication?

A nurse is reviewing the laboratory results of a client with PROM at 38 weeks of gestation. The nurse notes that the client has a positive culture for group B streptococcus. What is the most likely implication of this finding for the client and the fetus?

A nurse is performing a sterile speculum examination on a client with suspected PROM at 36 weeks of gestation.

The nurse observes a pool of clear fluid in the vagina.

What is the most appropriate action for the nurse to take next?