Which patient would correctly have the term "PPROM" listed in her chart by the provider?
A gravida 5, para 4 at 37 weeks who felt contractions at 17:00, SROM at 21:00, and now feeling the urge to push.
A gravida 3, para 1 at 36 weeks who stated her bag of waters broke at home at 21:00.
A gravida 2, para 1 at 32 weeks that has been having flank pain and pain with urination.
A gravida 1, para 0 at 39 weeks who felt leaking of fluid and came to be checked in triage.
The Correct Answer is B
Choice A rationale
PPROM stands for Preterm Premature Rupture of Membranes, meaning the rupture occurs before 37 weeks of gestation (preterm) and before the onset of labor (premature). This patient is at 37 weeks, which is considered full term (or early term), and the rupture of membranes (SROM) occurred after the onset of contractions, which is termed rupture of membranes (ROM) or SROM.
Choice B rationale
PPROM is the rupture of the amniotic sac (bag of waters) occurring before 37 weeks of gestation (preterm) and before the onset of labor (premature). This patient is at 36 weeks (preterm, as the normal range is 37-42 weeks), and the membranes ruptured at 21: at home, suggesting it happened before the onset of active, regular uterine contractions that mark labor initiation.
Choice C rationale
This describes a possible urinary tract infection (UTI) or pyelonephritis (flank pain). While infection is a risk factor for PPROM and preterm labor, the symptoms described are not the definition of PPROM, which is a rupture of the membranes (often described as a gush or trickle of fluid) before 37 weeks gestation. The symptoms relate to maternal health, not specifically the membrane status.
Choice D rationale
This patient is at 39 weeks of gestation, which is considered full term. Even if the membranes ruptured before the onset of labor (PROM), it is not preterm rupture of membranes (PPROM). The term used for membrane rupture at or after 37 weeks is typically Premature Rupture of Membranes (PROM), or simply SROM if labor has started. —. ##
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
While new parents need time to bond and establish their own family routines, a categorical statement telling grandparents to "leave you alone" is non-therapeutic and antagonistic. The nurse's role is to promote communication and identify resources, and grandparents can be significant sources of physical and emotional support, which is vital for maternal mental health and adjustment to parenthood.
Choice B rationale
A statement invoking the age or mortality of the grandparents uses emotional manipulation, which is inappropriate for a professional counseling relationship. This shifts the focus from the new parents' needs and the functional role of the grandparents to an appeal based on guilt or obligation, thus not providing an appropriate, objective explanation of their potential contribution.
Choice C rationale
Grandparents often possess a wealth of practical parenting knowledge and wisdom gained through experience, offering a positive resource for overwhelmed new parents. Furthermore, their involvement is crucial for the intergenerational transmission of cultural values and family history, helping the child develop a sense of identity and connection within the extended family structure.
Choice D rationale
While grandparent involvement can cause conflict if boundaries are not established, the blanket statement that it is "very disruptive" is judgmental and overgeneralized. The nurse should promote the potential benefits and then address potential conflicts by facilitating a conversation about establishing healthy boundaries and roles, which utilizes a more constructive and supportive approach.
Correct Answer is A
Explanation
Choice A rationale
Heat loss by convection occurs when body heat is transferred to cooler ambient air that is moving across the newborn's body surface. The fan blowing directly on the unwrapped infant creates a flow of cooler air, which accelerates heat loss from the infant's skin to the surrounding air. Keeping the baby wrapped and preventing air currents minimizes this mechanism to help maintain a neutral thermal environment.
Choice B rationale
Heat loss by conduction involves the transfer of heat from the newborn's body to a cooler solid surface with which the infant is in direct contact, such as a cold mattress or scale. The situation described (fan blowing on the unwrapped baby) does not involve direct contact with a cooler surface, so conduction is not the primary mechanism of heat loss here.
Choice C rationale
Heat loss by evaporation involves the vaporization of water from the newborn's moist skin or respiratory tract, such as from amniotic fluid immediately after birth or from sweat or insensible water loss. While some insensible loss occurs, the fan's action is primarily convection, as it moves cooler air over the infant, making evaporation an indirect or secondary concern.
Choice D rationale
While it is true that a newborn needs to be bundled to maintain a neutral thermal environment (NTE), stating this general fact does not answer the mother's "why" question regarding the specific mechanism of heat loss caused by the fan. The NTE is the range of ambient temperatures where metabolic rate and oxygen consumption are minimal to maintain a normal body temperature (36.5°C to 37.5°C). —.
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