Which condition should the nurse look for in the client's history that may explain an increase in the severity of afterpains?

Choice A rationale

Cystic fibrosis is an autosomal recessive genetic disorder caused by a mutation in the CFTR gene, affecting chloride transport and leading to production of abnormally thick mucus, primarily impacting the respiratory and digestive systems. It is a chronic condition and not an acute condition occurring immediately at birth requiring immediate surfactant administration through an endotracheal tube.

Choice B rationale

Bronchopulmonary dysplasia (BPD), sometimes referred to as chronic lung disease, is a long-term respiratory complication, mainly affecting premature infants who required prolonged mechanical ventilation and oxygen. It is characterized by abnormal lung development and fibrosis. While it is linked to prematurity, it is a chronic sequel, not the immediate neonatal condition that necessitates the initial surfactant intervention.

Choice C rationale

A pneumothorax is the presence of air in the pleural space, which collapses the lung and leads to acute respiratory distress. While it can occur in preterm infants, especially those on mechanical ventilation, it is a mechanical complication requiring a chest tube for air aspiration, not a condition caused by primary surfactant deficiency that is treated with exogenous surfactant administration.

Choice D rationale

Respiratory Distress Syndrome (RDS), historically called Hyaline Membrane Disease, is the leading cause of morbidity in premature infants. It results from a developmental deficiency of pulmonary surfactant, a lipoprotein that lowers alveolar surface tension. This deficiency causes widespread alveolar collapse (atelectasis) and decreased lung compliance, necessitating immediate exogenous surfactant replacement via the endotracheal tube to improve lung function.

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.