A client at 35 weeks gestation complains of pain whenever the baby moves.
The nurse notes the client’s temperature to be 101.20 F (38.4° C), with severe abdominal or uterine tenderness on palpation.
What condition do these findings suggest?

Abruptio placenta.

Chorioamnionitis.

Round ligament strain.

Viral infection.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Abruptio placenta is a condition where the placenta prematurely separates from the uterus. It typically presents with symptoms such as vaginal bleeding, back pain, and frequent contractions. However, the symptoms described by the client do not align with this condition.

Choice B rationale

Chorioamnionitis is an infection of the membranes surrounding the fetus and is associated with prolonged labor. Symptoms include fever, abdominal pain, and fetal tachycardia. The client’s symptoms of pain when the baby moves, a high temperature, and severe abdominal or uterine tenderness on palpation align with this condition.

Choice C rationale

Round ligament strain is a common cause of pain during pregnancy, particularly in the second trimester. It is caused by the stretching of the round ligaments that support the uterus.

However, it does not cause fever or severe abdominal tenderness.

Choice D rationale

While a viral infection could potentially cause a fever, it would not typically cause severe abdominal or uterine tenderness specifically when the baby moves.

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Correct Answer is ["6"]

Explanation

The correct answer is calculated as follows:

Step 1: Identify the total amount of oxytocin in the IV bag. The bag contains 20 units of oxytocin in 1 liter (or 1000 mL) of lactated Ringer’s solution.

Step 2: Convert the oxytocin units to milliunits. 1 unit = 1000 milliunits, so 20 units = 20,000 milliunits.

Step 3: Calculate the concentration of the oxytocin solution in milliunits/mL. Divide the total amount of oxytocin in milliunits by the total volume of the solution in mL.

So, 20,000 milliunits ÷ 1000 mL = 20 milliunits/mL.

Step 4: Calculate the infusion rate in mL/hour. The prescription is for an infusion rate of 2 milliunits/min. Since the concentration of the solution is 20 milliunits/mL, we divide the prescribed rate by the concentration to get the rate in mL/min. So, 2 milliunits/min ÷ 20 milliunits/mL = 0.1 mL/min.

Step 5: Convert the infusion rate to mL/hour. Multiply the rate in mL/min by the number of minutes in an hour. So, 0.1 mL/min × 60 min/hour = 6 mL/hour. Therefore, the nurse should program the infusion pump to deliver 6 mL/hour.

A. Notify the charge nurse about the patient’s condition. B. Discontinue the oxytocin infusion. C. Reduce the rate of the oxytocin infusion. D. Adjust the position of the fetal monitor transducers.

Correct Answer is B

Explanation

Choice A rationale

While notifying the charge nurse about the patient’s condition is an important step, it is not the immediate action that should be taken in this situation. The priority is to address the tachysystolic or tetanic contractions and variable fetal heart decelerations, which are signs of potential fetal distress.

Choice B rationale

Discontinuing the oxytocin infusion is the correct action. Oxytocin is a hormone that stimulates uterine contractions during labor. If a patient begins to experience tachysystolic or tetanic contractions, which are excessively frequent or prolonged contractions, it could lead to fetal distress. Discontinuing the oxytocin can help reduce the frequency and intensity of the contractions.

Choice C rationale

Reducing the rate of the oxytocin infusion may not be sufficient in this situation. Tachysystolic or tetanic contractions with variable fetal heart decelerations are serious signs that require immediate action. Simply reducing the rate of the infusion may not alleviate these symptoms quickly enough.

Choice D rationale

Adjusting the position of the fetal monitor transducers would not address the issue of tachysystolic or tetanic contractions. While it is important to ensure accurate monitoring of the fetus, the priority in this situation is to address the potentially harmful contractions.

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A client at 35 weeks gestation complains of pain whenever the baby moves.The nurse notes the client’s temperature to be 101.20 F (38.4° C), with severe abdominal or uterine tenderness on palpation.What condition do these findings suggest?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who is scheduled for induction of labor receives a prescription for oxytocin 2 milliunits/min intravenously (IV). The IV bag contains oxytocin 20 units in lactated Ringer’s 1 liter. How many mL/hour should the nurse program the infusion pump to deliver? .

Correct Answer is ["6"]

Explanation

A patient in early labor is receiving oxytocin and begins to experience tachysystolic or tetanic contractions with variable fetal heart decelerations.What should the nurse do next?

Correct Answer is B

Explanation

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A client at 35 weeks gestation complains of pain whenever the baby moves.
The nurse notes the client’s temperature to be 101.20 F (38.4° C), with severe abdominal or uterine tenderness on palpation.
What condition do these findings suggest?