When planning the care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman’s risk for has increased.
Paceritation.
Shoulder dystocia.
Infection.
Meconium aspiration.
The Correct Answer is C
Choice A rationale
Paceritation is a term not commonly recognized in obstetrics. It lacks clinical relevance and does not correlate with increased risk during labor when membranes rupture.
Choice B rationale
Shoulder dystocia occurs during delivery when the baby's shoulder gets stuck after the head is delivered. It is unrelated to ruptured membranes and does not increase the associated risk.
Choice C rationale
Infection risk increases significantly after membranes rupture due to potential bacterial entry into the uterine cavity. Normal WBC count is 4,000-11,000 cells/mcL.
Choice D rationale
Meconium aspiration occurs when the newborn inhales meconium-stained amniotic fluid, typically in post-term pregnancies or fetal distress. It is not directly linked to ruptured membranes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Testing the fluid with nitrazine paper can confirm membrane rupture but is not the first priority. Assessing the fetal heart rate is crucial to ensure fetal well-being immediately after membrane rupture.
Choice B rationale
Documenting the time of rupture is important for clinical records but is not the first priority. Immediate assessment of fetal status takes precedence to detect any distress.
Choice C rationale
Monitoring the fetal heart rate and pattern immediately after membrane rupture is essential to ensure the fetus is not in distress. It helps detect any complications like cord prolapse.
Choice D rationale
Notifying the physician or midwife is necessary but not the first priority. Ensuring fetal well-being through heart rate monitoring is the immediate concern following membrane rupture.
Correct Answer is B
Explanation
Choice A rationale
Notifying the provider is important but does not address the immediate need to assess the patient's progress and readiness for delivery. A direct intervention is required to determine the next steps.
Choice B rationale
Performing a sterile vaginal exam allows the nurse to assess cervical dilation and effacement, fetal station, and presentation, which are crucial to determine if the patient is ready to push and proceed with delivery.
Choice C rationale
Supportive words and care are essential for patient comfort, but they do not provide the necessary assessment to determine the patient's progress in labor or readiness for pushing.
Choice D rationale
Monitoring the fetal heart rate tracing is important for assessing fetal well-being but does not specifically address the patient's readiness to push or her labor progress.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.