A nurse is reviewing the medical record of a client who is at 34 weeks of gestation and has pre-term labor.
Which of the following findings is a risk factor for pre-term labor?
History of urinary tract infections
Maternal age of 25 years
Singleton pregnancy
Cervical length of 3 cm
The Correct Answer is A
History of urinary tract infections. According to the Mayo Clinic, untreated vaginal infections, such as urinary tract infections or sexually transmitted infections, are risk factors for preterm labor.
These infections can cause inflammation and irritation of the cervix, which can trigger contractions and cervical dilation.
Choice B is wrong because maternal age of 25 years is not a risk factor for preterm labor. In fact, women younger than 18 or older than 35 are more likely to have a preterm delivery.
Choice C is wrong because singleton pregnancy is not a risk factor for preterm labor. On the contrary, being pregnant with twins, triplets, or more (called "multiple gestations") is associated with a higher risk of preterm labor and birth.
Choice D is wrong because cervical length of 3 cm is not a risk factor for preterm labor. A short cervix (less than 2.5 cm) or a cervix that shortens in the second trimester instead of the third trimester is a risk factor for preterm delivery. A normal cervical length ranges from 3 to 5 cm during pregnancy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Assess fetal heart rate and activity.
The nurse should identify that a client who reports a sudden gush of fluid from her vagina is at risk forpremature rupture of membranes (PROM), which can lead toinfection,cord prolapse, andfetal distress.Therefore, the priority action is to assess the fetal heart rate and activity to monitor for signs of hypoxia or distress.
Choice B is wrong because performing a nitrazine test on the fluid is not the first action.A nitrazine test can confirm the presence of amniotic fluid by detecting its alkaline pH, but it is not as urgent as assessing the fetal well-being.
Choice C is wrong because administering oxytocin (Pitocin) IV infusion is contraindicated in this situation.Oxytocin is used to induce or augment labor, but it can causeuterine hyperstimulation,fetal distress, andplacental abruptionif given to a client who has PROM.
Choice D is wrong because placing the client in Trendelenburg position is not recommended for a client who has PROM.Trendelenburg position can increase the risk ofcord prolapseandaspirationin this situation.
Correct Answer is ["B","C","D","E"]
Explanation
Magnesium sulfate IV infusion can cause various adverse effects such asflushing,headache,nauseaanddrowsiness.
These are common and expected side effects of this medication.
Choice A is wrong because magnesium sulfate IV infusion does not causediarrhea.Diarrhea is a possible side effect of oral magnesium sulfate, which is used as a laxative.
However, oral magnesium sulfate is not used to treat pre-term labor or prevent seizures.
Normal ranges of magnesium in the blood are 1.7 to 2.2 mg/dL for adults.
Magnesium sulfate IV infusion is used to treat hypomagnesemia (low levels of magnesium in the blood) or to prevent seizures in pregnant women with pre-eclampsia, eclampsia or toxemia.
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