A nurse is caring for a client who is in preterm labor with a current L/S ratio of 1:1. Which of the following actions should the nurse take?
Administer betamethasone 12 mg IM.
Prepare the client for immediate delivery.
Administer hydralazine 25 mg IV.
Infuse a bolus of IV fluid.
The Correct Answer is A
Choice A rationale
Administering betamethasone 12 mg IM helps accelerate fetal lung maturity by stimulating the production of surfactant. This is crucial for a preterm baby, as immature lungs are one of the biggest risks in preterm labor. Administering betamethasone can significantly improve neonatal outcomes by reducing respiratory distress syndrome and other complications related to prematurity.
Choice B rationale
Preparing the client for immediate delivery is not the first action as the primary goal in managing preterm labor with an L/S ratio of 1: is to delay labor and enhance fetal lung maturity. Betamethasone administration is prioritized to maximize fetal lung development before considering delivery.
Choice C rationale
Administering hydralazine 25 mg IV is used to manage hypertension and is unrelated to enhancing fetal lung maturity in preterm labor. It is not indicated in this situation as the primary concern is not managing blood pressure.
Choice D rationale
Infusing a bolus of IV fluid might be used to manage preterm labor but does not directly address the need to improve fetal lung maturity. The main priority is administering steroids like betamethasone to expedite fetal lung development.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
At 9 weeks gestation, the primary purpose of an ultrasound is to confirm the presence of a fetal heartbeat, which indicates a viable pregnancy.
Choice B rationale
Chromosomal defects are typically assessed using different tests, such as chorionic villus sampling or amniocentesis, rather than an ultrasound at this early stage.
Choice C rationale
Fetal lung maturity cannot be assessed at 9 weeks gestation because the lungs are not yet developed. This assessment is usually done later in pregnancy if preterm delivery is anticipated.
Choice D rationale
The position of the fetus in utero is not a concern at this early stage of pregnancy. Fetal positioning becomes relevant later in pregnancy, closer to delivery.
Correct Answer is ["B","C","D","E"]
Explanation
Choice A rationale
Do not gain more than 25 pounds in pregnancy due to body image issues is incorrect. Gaining an appropriate amount of weight based on individual health and pregnancy needs is important, and it should not be restricted based on body image concerns.
Choice B rationale
Continue to take your prenatal vitamin every day is correct. Prenatal vitamins are essential in providing the necessary nutrients for both the mother and developing fetus, including folic acid, iron, and calcium.
Choice C rationale
Avoid alcohol, tobacco, and drugs is correct. These substances can have harmful effects on fetal development and should be avoided to ensure a healthy pregnancy.
Choice D rationale
Do not eat more than 12 ounces of low mercury fish each week is correct. While fish can be a good source of protein and omega-3 fatty acids, it's important to limit intake of fish that may contain higher levels of mercury to avoid potential harm to the fetus.
Choice E rationale
Increase caloric intake by 100-200 a day is correct. Pregnant teens need additional calories to support their own growth as well as that of the fetus, but the increase should be moderate and balanced with nutritional needs. .
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