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A nurse in an antepartum unit is caring for a client.

Exhibits

For each potential assessment finding, click to specify if the finding is consistent with chorioamnionitis or preeclampsia. Each finding may support more than one disease process.

A.

Purulent amniotic fluid

B.

Elevated uric acid level

C.

Fever

D.

Decreased platelet count

E.

Blurred vision

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"B"},"E":{"answers":"B"}}

Findings Consistent with Chorioamnionitis:

  • Purulent amniotic fluid
  • Fever

Findings Consistent with Preeclampsia:

  • Elevated uric acid level
  • Decreased platelet count
  • Blurred vision

Rationale:

  • Purulent amniotic fluid (Chorioamnionitis): Chorioamnionitis is an intra-amniotic infection, often leading to foul-smelling, purulent, or discolored amniotic fluid.
  • Fever (Chorioamnionitis): Maternal fever is a hallmark sign of chorioamnionitis, indicating infection.
  • Elevated uric acid level (Preeclampsia): Uric acid elevation is associated with endothelial dysfunction and reduced renal clearance seen in preeclampsia.
  • Decreased platelet count (Preeclampsia): Thrombocytopenia can occur due to platelet consumption in severe preeclampsia or HELLP syndrome.
  • Blurred vision (Preeclampsia): Visual disturbances occur due to cerebral edema and vasospasms, common in preeclampsia.


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Related Questions

Correct Answer is B

Explanation

A. Obtain a tympanogram reading prior to initiating the test. This is incorrect because a tympanogram assesses middle ear function and is not part of the Weber test, which evaluates hearing loss type.
B. Place a vibrating tuning fork on the top of the child's head. This is correct because the Weber test involves placing a vibrating tuning fork on the midline of the skull to determine if sound is heard equally in both ears, helping to differentiate between conductive and sensorineural hearing loss.
C. Hold a vibrating tuning fork 1 to 2 cm (0.4 to 0.8 in) from the child's ears. This is incorrect because this describes the Rinne test, which compares air conduction to bone conduction.
D. Measure the amount of time the child can hear the sound. This is incorrect because the Weber test does not measure duration but assesses lateralization of sound perception.

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"}}

Explanation

Anticipated Interventions:

  • Initiate an IV infusion of lactated Ringer's
  • Place the client in a left lateral position
  • Maintain continuous monitoring of the FHR

Contraindicated Intervention:

  • Monitor blood pressure every hour

Rationale:

  • Initiate an IV infusion of lactated Ringer’s: Hydration is important for labor progression and maternal hemodynamic stability, especially considering the client has a history of chronic hypertension and gestational diabetes.
  • Place the client in a left lateral position: This improves uteroplacental perfusion, helping to optimize fetal oxygenation.
  • Maintain continuous monitoring of the FHR: The presence of meconium-stained amniotic fluid and an elevated FHR (165/min) suggests potential fetal distress, warranting continuous fetal monitoring.
  • Monitor blood pressure every hour (Contraindicated): The client has chronic hypertension and gestational diabetes, both of which increase the risk for complications like preeclampsia and fetal distress. More frequent BP monitoring (e.g., every 15-30 minutes) is necessary to detect any abnormalities early.

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