RN Nursing · High-Risk Pregnancy — Preterm Labor · Practice question
Complete the diagram by click from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
Pregnant Client at 31 Weeks with Vaginal Fluid Leaking (Question 174)
Vital Signs
Blood pressure 128/88 mm Hg Heart rate 88/min Respiratory rate 20/min Temperature 37.4° C (99.3° F) SaO2 97% on room airNurses' Notes
Client is at 31 weeks of gestation. Fundal height 32 cm. No edema. Client denies headache or visual changes. Client reports a small amount of clear fluid from the vagina for past 2 hr. Client denies contractions, pelvic pressure, or back pain. Uterus soft to palpation, client denies tenderness. Electronic fetal monitoring applied, no contractions noted in 20 min. FHR 148/min with moderate variability. Cervical examination by provider reveals cervix closed, thick, and firm. No presenting part palpable. Small amount of clear fluid noted on client's perineal pad.Laboratory Results
WBC count 9,000/mm³ (5,000 to 15,000/mm³) Hgb 11.5 g/dL (11 to 16 g/dL) Hct 39% (33% to 47%) Platelet count 320,000/mm³ (150,000 to 400,000/mm³) Vaginal fluid analysis: PH: Elevated (Nitrazine positive) Urine analysis: Glucose: None (expected: none) pH 6.1 (4.6 to 8) Specific gravity 1.015 (1.005 to 1.030) Protein 3 mg/dL (0 to 8 mg/dL) Ketones: None (expected: none) Nitrites: Present (expected: none)Answer & explanation
Correct:
The client at 31 weeks presents with clear fluid leaking vaginally for 2 hours, a Nitrazine-positive vaginal fluid pH (elevated), and nitrites in urine suggesting UTI. The cervix is closed but fluid is noted on the perineal pad, supporting PPROM. HELLP is ruled out by normal lab values. Placenta previa typically presents with painless bright red bleeding. Intrahepatic cholestasis presents with pruritus and elevated bile acids. For PPROM, betamethasone is given to accelerate fetal lung maturity, and antibiotics (e.g., ampicillin) are given to prevent/treat infection and prolong latency. FHR monitoring and temperature monitoring detect fetal distress and maternal chorioamnionitis (ATI Maternal-Newborn, High-Risk Pregnancy — Preterm Labor).
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- The nurse is caring for a patient who is threatening preterm labor and has been given glucocorticoids. What is the purpose of glucocorticoid administration?
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- A nurse is preparing to administer magnesium sulfate 2 g/hr IV to a client who is in preterm labor. Available is 20 g magnesium sulfate in 500 mL of dextrose 5% in water (D5W). The nurse should set the IV infusion pump to administer how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
- A nurse is admitting a client who is at 30 weeks of gestation and is in preterm labor. The client has a new prescription for betamethasone and asks the nurse about the purpose of this medication. The nurse should provide which of the following explanations?