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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 A

Explanation

A. Keeping the umbilical cord area clean and dry helps prevent infection. Washing the base of the cord with water is recommended, while avoiding full immersion in water until the cord falls off.
B. The diaper should be folded down below the cord to prevent moisture buildup and irritation. Covering it can trap moisture and increase the risk of infection.
C. Minor bleeding is not expected when the stump falls off. Persistent or excessive bleeding should be reported to the provider.
D. Petroleum jelly is not recommended for umbilical cord care. The cord should be kept dry to facilitate natural detachment.

Correct Answer is A

Explanation

A. Reminding the AP about confidentiality is the appropriate immediate response. The nurse should provide education and reinforce HIPAA regulations to prevent future breaches.
B. Notifying the client is unnecessary and could cause undue distress. The priority is to address the behavior and prevent further violations.
C. Notifying the ethics committee is excessive for a first-time or minor violation. This step may be necessary if breaches continue despite education.
D. Filing an incident report is not required unless the breach has significant consequences. The best first step is direct education.

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