A nurse is teaching a client with preterm premature rupture of membranes (PPROM) regarding self-care activities. Which activities should the nurse include in her teaching?
Tampons are safe to use to absorb the leaking amniotic fluid.
Report a temperature less than 37 degrees C.
Do not engage in sexual activity.
Taking frequent tub baths is safe.
The Correct Answer is C
Choice A reason: Tampons are not safe to use to absorb the leaking amniotic fluid, because they can introduce bacteria into the vagina and uterus, and increase the risk of infection and preterm labor. The nurse should instruct the client to use sanitary pads instead, and change them frequently.
Choice B reason: Reporting a temperature less than 37 degrees C is not a necessary activity, because it is a normal finding and does not indicate any complication. The nurse should instruct the client to report a temperature greater than 37.8 degrees C, which can be a sign of infection or chorioamnionitis.
Choice C reason: Not engaging in sexual activity is a recommended activity, because it can help prevent further rupture of membranes, infection, and preterm labor. The nurse should instruct the client to avoid any vaginal or cervical stimulation, such as intercourse, douching, or tampon use.
Choice D reason: Taking frequent tub baths is not a safe activity, because it can expose the vagina and uterus to contaminated water, and increase the risk of infection and preterm labor. The nurse should instruct the client to take showers instead, and avoid submerging the lower body in water.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Glipizide is not an appropriate medication for the client, because it is a sulfonylurea that can cross the placenta and cause fetal hypoglycemia, hyperinsulinemia, and macrosomia. Glipizide is contraindicated in pregnancy.
Choice B reason: Acarbose is not an appropriate medication for the client, because it is an alpha-glucosidase inhibitor that can cause gastrointestinal side effects, such as flatulence, diarrhea, and abdominal pain. Acarbose is not recommended in pregnancy.
Choice C reason: Glyburide is an appropriate medication for the client, because it is a sulfonylurea that has a low placental transfer and a minimal risk of fetal hypoglycemia. Glyburide is considered safe and effective in pregnancy.
Choice D reason: Repaglinide is not an appropriate medication for the client, because it is a meglitinide that can cross the placenta and cause fetal hypoglycemia and teratogenic effects. Repaglinide is contraindicated in pregnancy.
Correct Answer is C
Explanation
Choice A reason: Initiation of pushing is not an appropriate nursing action, as it can increase the bleeding and the risk of placental separation, which can cause fetal hypoxia, hemorrhage, or shock. Pushing is contraindicated in clients with placenta previa, which is a condition where the placenta covers the cervical opening and can cause painless, bright red bleeding in the third trimester.
Choice B reason: Examination to determine cervical status is not an appropriate nursing action, as it can cause trauma and perforation of the placenta, which can lead to severe bleeding and infection. Examination is contraindicated in clients with placenta previa, unless it is confirmed by ultrasound that the placenta is not low-lying or covering the cervix.
Choice C reason: Preparation for cesarean birth is an appropriate nursing action, as it is the preferred mode of delivery for clients with placenta previa, especially if the bleeding is heavy, the fetus is mature, or the fetal distress is present. Cesarean birth can prevent the complications of placenta previa, such as fetal hypoxia, hemorrhage, or shock.
Choice D reason: A magnesium sulfate infusion is not an appropriate nursing action, as it is a drug that prevents seizures and lowers the blood pressure in clients with severe preeclampsia, which is a hypertensive disorder of pregnancy. Magnesium sulfate is not indicated for clients with placenta previa, unless they also have severe preeclampsia or eclampsia.
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