A nurse is caring for a client who is at 37 weeks of gestation and reports a slow trickle of vaginal fluid for the past 12 hours.
Which of the following diagnostic tests should the nurse anticipate?
Speculum exam to test for fetal fibronectin.
Vaginal swab for nitrazine testing.
Urinalysis to determine protein content.
Amniocentesis to determine fetal lung maturity.
The Correct Answer is B
Choice A rationale
A speculum exam to test for fetal fibronectin is primarily used to predict the risk of preterm labor in symptomatic women between 22 and 34 weeks of gestation. Since the client is at 37 weeks of gestation (term) and the concern is a slow trickle of fluid suggesting rupture of membranes (ROM), this test is not appropriate for the current clinical presentation or gestational age.
Choice B rationale
Nitrazine testing is a rapid, non-invasive method used to determine if the fluid leaking from the vagina is amniotic fluid. Amniotic fluid is alkaline (pH of 7.0 to 7.5) and will turn the yellow-to-orange nitrazine paper to a characteristic deep blue color, which helps confirm the diagnosis of premature rupture of membranes (PROM), a likely cause of the reported fluid trickle.
Choice C rationale
A urinalysis determines components like protein, glucose, and ketones, and is mainly used to screen for conditions such as preeclampsia (indicated by proteinuria) or urinary tract infection (UTI). While part of routine prenatal care, it is not the diagnostic test for confirming ruptured membranes, which is the primary concern given the client's report of a slow trickle of vaginal fluid.
Choice D rationale
Amniocentesis is an invasive procedure used to aspirate amniotic fluid, typically to assess fetal lung maturity (L/S ratio) or for genetic testing. Since the client is at 37 weeks and the suspicion is ruptured membranes, which warrants immediate action due to infection risk, the risks and benefits of an amniocentesis for lung maturity are not justified.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While seizures are a serious adverse effect of ergot alkaloids, they are primarily associated with the most severe form of ergotism, which is an overdose or prolonged exposure, or in clients with severe preeclampsia/eclampsia. Methylergonovine's more common and immediate adverse effect is its potent vasoconstrictive property, leading to elevated blood pressure.
Choice B rationale
Methylergonovine is an ergot alkaloid that acts as a potent vasoconstrictor and smooth muscle contractor, primarily on the uterus to treat postpartum hemorrhage and uterine atony. Its generalized vasoconstrictive effect, however, can lead to a significant elevation in blood pressure, making hypertension (blood pressure greater than 140/90 mmHg or an increase of 20 mmHg or more) a major and frequent adverse effect.
Choice C rationale
Methylergonovine's potent vasoconstrictive action typically causes an increase in peripheral vascular resistance, which often results in bradycardia (heart rate less than 60 beats/min) as a reflex response to the elevated blood pressure. Tachycardia (heart rate greater than 100 beats/min) is not a typical adverse effect of this medication.
Choice D rationale
Methylergonovine acts mainly on the smooth muscle of the uterus and blood vessels; it does not typically cause water retention. Water retention is more commonly associated with conditions like preeclampsia or medications such as glucocorticoids. The adverse effects of methylergonovine center around vasoconstriction and uterine cramping.
Correct Answer is C
Explanation
Choice A rationale
Although antiviral medications such as acyclovir or valacyclovir can suppress viral replication and reduce the frequency, duration, and severity of outbreaks, they do not eliminate the virus from the body. Genital herpes simplex virus (HSV-2) infection is a chronic, lifelong condition for which there is currently no known cure, therefore, medication will only manage the symptoms.
Choice B rationale
Genital herpes simplex virus (HSV-2) can be transmitted vertically from mother to fetus or newborn, particularly during a primary infection in pregnancy or during vaginal birth. Neonatal herpes infection can be severe or fatal, causing disseminated disease, central nervous system involvement, or mucocutaneous lesions, thus, it is a significant risk to the developing fetus/newborn.
Choice C rationale
The risk of neonatal transmission of HSV-2 is significantly higher (around 25.
Choice D rationale
Wearing tight-fitting undergarments can increase heat and moisture in the genital area, leading to friction and irritation of the lesions, which can prolong healing and increase discomfort during an outbreak. Clients are advised to wear loose-fitting cotton undergarments to keep the area dry and promote air circulation, which helps with lesion healing.
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