A nurse is teaching a pregnant woman with preterm prelabor rupture of membranes about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching?

I need to call my doctor if my temperature increases."

can shower, but I shouldn't take a tub bath."

"I need to keep a close eye on how active my baby is each day."

"It's okay for my husband and me to have sexual intercourse."

Answer and Explanation

The Correct Answer is D

A. "I need to call my doctor if my temperature increases." This is an appropriate and accurate statement. An elevated temperature could be a sign of infection, which is a risk for women with preterm prelabor rupture of membranes (PPROM). The woman should contact her healthcare provider if her temperature rises, as infection can lead to complications.

B. "I can shower, but I shouldn't take a tub bath." This is also correct. After PPROM, the woman is typically allowed to shower to maintain personal hygiene, but taking a tub bath can increase the risk of infection by allowing bacteria to enter the vagina.

C. "I need to keep a close eye on how active my baby is each day." This is a correct and helpful statement. Monitoring fetal movement is important for assessing the baby's well-being. Decreased fetal movement could indicate a potential problem, and the woman should contact her provider if she notices reduced activity.

D. "It's okay for my husband and me to have sexual intercourse." This statement indicates a need for additional teaching. Sexual intercourse is typically not recommended after PPROM because it could increase the risk of infection, especially if the membranes are ruptured. The woman should avoid sexual activity until advised otherwise by her healthcare provider.

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Correct Answer is A

Explanation

A. Ice helps to reduce swelling, numb the area, and relieve pain during the first 24 hours after an episiotomy. Applying ice immediately after birth can help minimize discomfort and inflammation.

B. Offer warm blankets may provide comfort but will not specifically target pain relief or swelling at the site of the episiotomy.

C. Offer a warm sitz bath is beneficial for postpartum healing and pain relief but should not be used immediately after the procedure. Warm sitz baths are typically recommended after the first 24 hours to promote relaxation and improve blood circulation.

D. Encourage the woman to void is important for overall comfort and bladder function but will not directly address the pain from the episiotomy.

A. 7 B. 8 C. 5 D. 9

Correct Answer is B

Explanation

A. A score of 7 would be given if the infant’s heart rate was 100, but with less than optimal responses for color, muscle tone, and respiratory effort. However, this baby demonstrates strong responses in all categories.

B. The Apgar score is calculated based on five criteria: heart rate, respiratory effort, muscle tone, reflex irritability, and color. The infant in the scenario has:

Heart rate of 100 (score 2)

Pink body and blue hands (score 1 for color—because the baby is not fully pink, indicating some cyanosis in the extremities)

Active motion (score 2 for muscle tone)

Strong lusty cry (score 2 for reflex irritability/responsiveness to stimuli)

Good respirations (score 2)

Adding these scores (2 + 1 + 2 + 2 + 2), the total is 8.

C. A score of 5 would indicate more significant distress, with poor color, respiratory effort, and muscle tone. This infant is showing good signs of adaptation.

D. A score of 9 would indicate that the baby has no signs of cyanosis and perfect responses in all categories, but since the infant has blue hands, it scores slightly lower (1 point less for color).

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A nurse is teaching a pregnant woman with preterm prelabor rupture of membranes about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who has just given birth to a healthy newborn required an episiotomy. Which action would the nurse implement immediately after birth to decrease the client's pain from the procedure?

Correct Answer is A

Explanation

The nurse is performing an Apgar score on a newborn at 5 minutes after birth. The infant has a heart rate of 100, pink body and blue hands, active motion, and a strong lust cry and respirations. What is the Apgar score that should be assigned to this infant?

Correct Answer is B

Explanation

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