A pregnant woman's membranes ruptured prematurely at 34 weeks.
She will be discharged to her home for the next few weeks.
What would the nurse planning discharge instruction teach the woman to do?
Notify her obstetrician if she has a temperature above 100.4°F.
Rest in a side-lying Trendelenburg's position with hips elevated.
Report any increase in fetal activity.
Massage her breasts to promote uterine relaxation.
The Correct Answer is A
Choice A rationale
Premature rupture of membranes (PROM) at 34 weeks significantly increases the risk of chorioamnionitis (intra-amniotic infection), as the protective barrier is breached. Infection is a major complication in this scenario. The cardinal symptom the woman should monitor for is a maternal fever, which is a temperature ≥ 100.4° F (or 38° C), requiring immediate notification of the obstetrician for prompt diagnosis and antibiotic treatment to prevent maternal and fetal sepsis.
Choice B rationale
The modified Trendelenburg position (head slightly down, hips elevated) is sometimes used in an acute setting following a prolapsed umbilical cord to reduce pressure on the cord. It is not a standard, routine recommendation for home care following PROM at 34 weeks, as prolonged bed rest carries risks, and the primary home teaching focuses on infection surveillance and activity restriction.
Choice C rationale
A decrease in fetal activity (less than ten movements in two hours) is the key warning sign of potential fetal compromise (e.g., hypoxia or infection) that the woman should report immediately. An increase in fetal activity is generally considered a normal, positive finding, often in response to maternal stimuli or a change in the fetal sleep cycle.
Choice D rationale
Nipple or breast massage stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is a powerful uterine contractile agent and is used for labor induction and postpartum hemorrhage control. In a woman with PROM, this action could potentially stimulate labor, which is generally not the goal if the pregnancy can be safely prolonged.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Elbow restraints (or 'no-no' restraints) are critical to prevent the toddler from placing their fingers, hands, or foreign objects into their mouth. Postoperative care for a cleft palate repair focuses on protecting the delicate surgical site from trauma, as mechanical stress or contamination can lead to dehiscence (surgical wound separation) or infection, compromising the success of the repair and potentially necessitating further surgery. The restraints must be applied consistently and correctly, with regular neurovascular checks.
Choice B rationale
Suctioning the nose and mouth can potentially cause trauma to the surgical site, introducing a high risk of damaging the newly repaired palate tissue, which is fragile. Secretions are best managed by positioning (e.g., side-lying or on the abdomen immediately post-op) and gentle wiping of the lips, allowing gravity and gentle oral hygiene to clear secretions. Suctioning should be avoided unless absolutely necessary for an airway obstruction, and then it must be done with extreme caution.
Choice C rationale
Soft foods still require mastication and may put undue pressure or stress on the newly repaired palate. For a 14-month-old, the plan should typically involve a liquid diet only for the initial postoperative period, often followed by a gradual progression to a pureed diet, and then soft foods, usually several weeks post-surgery, to ensure the surgical site is completely protected during the crucial healing phase.
Choice D rationale
Hard-tipped sippy cups and straws should be strictly avoided as the rigid plastic tip or the sucking motion can exert direct mechanical force or shearing stress on the incision line. This direct trauma significantly increases the risk of damaging the sutures and causing dehiscence, which would impair healing. Fluids must be administered via a syringe, dropper, or soft-tipped cup to minimize contact and force on the palate.
Correct Answer is C
Explanation
Choice A rationale
Nalbuphine (Nubain) is an opioid agonist-antagonist analgesic frequently used for pain relief during labor. Its pharmacological action involves κ-receptor agonism and μ-receptor partial antagonism. While opioids can affect the cardiovascular system, bradycardia (a slow heart rate, <110 bpm in a fetus) is less common than tachycardia or minimal fetal heart rate variability. Bradycardia is a known adverse effect of some medications, but respiratory depression is the primary, most significant opioid-related risk.
Choice B rationale
Nalbuphine generally does not cause hypertension (high blood pressure). In fact, common cardiovascular side effects of opioids can include orthostatic hypotension due to peripheral vasodilation and histamine release, though its overall impact on maternal blood pressure is usually minimal or transient. The most critical adverse reaction concerning patient safety, especially in the neonate after delivery, relates to respiratory function due to medullary effects.
Choice C rationale
Respiratory depression is the most significant adverse reaction associated with nalbuphine, as with other opioids, due to its depressant effect on the respiratory center in the brainstem (medulla). It decreases the sensitivity of the respiratory center to carbon dioxide, leading to a reduced rate and depth of respiration. This risk is present for the mother and can cross the placenta, potentially causing neonatal respiratory depression, especially if administered close to delivery.
Choice D rationale
Hyperglycemia (elevated blood glucose) is not a commonly reported or primary adverse effect of nalbuphine. Opioids can sometimes affect glucose metabolism, but the more significant and clinically relevant adverse effects relate to the central nervous system and respiratory function. Nalbuphine's primary mechanism of action doesn't directly involve the pancreatic hormones or glucose regulation pathways in a clinically significant manner leading to hyperglycemia.
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