A client's membranes spontaneously ruptured, as evidenced by a gush of clear fluid with a contraction.

What would the nurse do next?

Notify the primary care provider immediately.

Perform a vaginal exam.

Change the linen saver pad.

Check the fetal heart rate.

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Notifying the primary care provider is important but not the immediate next step. The nurse has other immediate responsibilities to ensure the safety of the mother and baby.

Choice B rationale:

A vaginal exam could introduce bacteria into the uterus and is not the immediate next step after rupture of membranes.

Choice C rationale:

Changing the linen saver pad is not the immediate next step. While it might be necessary for the comfort of the mother, it does not address the potential risks associated with rupture of membranes.

Choice D rationale:

Checking the fetal heart rate is the correct next step. This ensures that the baby is not in distress following the rupture of membranes.

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Correct Answer is A

Explanation

Choice A rationale:

Fundal height measurement is a common procedure during prenatal visits to monitor the baby’s growth.

Choice B rationale:

While ultrasounds are performed during pregnancy, they aren’t typically done at every prenatal visit.

Choice C rationale:

Urine cultures are important for detecting urinary tract infections, but they aren’t a routine part of every prenatal visit.

Choice D rationale:

Hemoglobin and hematocrit tests are done to check for anemia, but they aren’t typically performed at every visit.

A. A shallow deceleration occurring with the beginning of contractions. B. Fetal heart rate declining late with contractions and remaining depressed. C. Fetal baseline rate increasing at least 5 mm Hg with contractions. D. Variable decelerations, too unpredictable to count.

Correct Answer is B

Explanation

hoice A rationale:

This is incorrect. A shallow deceleration at the beginning of contractions is not indicative of uteroplacental insufficiency.

Choice B rationale:

This is correct. Late decelerations of the fetal heart rate during contractions can indicate uteroplacental insufficiency.

Choice C rationale:

This is incorrect. An increase in baseline heart rate with contractions is not a typical sign of uteroplacental insufficiency.

Choice D rationale:

This is incorrect. Variable decelerations are typically associated with cord compression, not uteroplacental insufficiency.

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A client's membranes spontaneously ruptured, as evidenced by a gush of clear fluid with a contraction. What would the nurse do next?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When assessing a woman at follow-up prenatal visits, the nurse would anticipate which procedure to be performed?.

Correct Answer is A

Explanation

If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor?.

Correct Answer is B

Explanation

Your patient is receiving Heparin via a continuous IV infusion at a rate of 1600 units per hour. The bag is labeled N/S 500 mLs and contains Heparin 40,000 units. What rate should the IV pump be set at to deliver this ordered amount of Heparin? mLs/hr.

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A client has just given birth to a healthy baby boy, but the placenta has not yet delivered. What stage of labor does this scenario represent?.

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When teaching a group of postmenopausal women about hot flashes and night sweats, the nurse would address which primary cause?.

A client's membranes spontaneously ruptured, as evidenced by a gush of clear fluid with a contraction.

What would the nurse do next?