The RN interprets the following external fetal monitoring strip as:

Rationale for correct condition: The client is likely experiencing PPROM, as evidenced by the sudden gush of clear fluid and continued light leakage, confirmed by fluid pooling in the vaginal vault that tested positive for ferning. PPROM can lead to preterm labor and increased risk of infection. The absence of contractions or bleeding, and the mild lower abdominal discomfort, further supports this diagnosis.

Rationale for actions: Administering prophylactic antibiotics helps prevent infection, which is a significant risk with PPROM. Educating the client on kick counts ensures monitoring of fetal well-being. Preparing for an emergent C-section is not immediately necessary as the cervix is closed. Providing IV fluids for hypotension is not applicable here as blood pressure is elevated. Discharging the client with follow-up in one week is inappropriate given the risk of infection and preterm labor.

Rationale for parameters: Monitoring signs of infection is crucial, as PPROM increases infection risk. Maternal blood pressure trends must be watched due to elevated readings, suggesting possible complications. Meconium-stained amniotic fluid, while concerning, is not present. Maternal platelet levels and fundal height measurements do not directly address the current risks associated with PPROM.

Rationale for incorrect conditions: Placental abruption typically involves abdominal pain and bleeding, which are absent. Preeclampsia involves hypertension and proteinuria, but no significant proteinuria is present. Oligohydramnios involves decreased amniotic fluid, but the client reports clear fluid leakage indicating rupture of membranes.

Choice A rationale

A temperature of 37.8°C (100.3°F) is a low-grade fever that does not typically indicate a serious issue in the context of epidural analgesia during labor. It should be monitored, but it's not immediately concerning.

Choice B rationale

Generalized itching can be a common side effect of epidural analgesia due to the opioids used. It should be monitored and managed, but it does not typically require immediate physician notification.

Choice C rationale

Weakness of the lower extremities can be expected with epidural analgesia as it causes a loss of sensation and muscle control. This should be monitored, but it is not typically an emergency.

Choice D rationale

Fetal bradycardia is a serious concern that must be reported to the physician immediately. It can indicate fetal distress and requires urgent evaluation and intervention to ensure the well-being of the baby. .