A patient’s amniotic fluid is meconium-stained. Which action should the nurse plan to take?
Take the mother’s vital signs every 15 minutes.
Send a specimen of the fluid to the laboratory for analysis.
Have a suction catheter available for use at delivery.
Prepare a slide of the fluid for fern testing.
The Correct Answer is C
The correct answer is choice C. Have a suction catheter available for use at delivery. This is because meconium-stained amniotic fluid indicates that the fetus has passed meconium (first stool) before birth, which can be a sign of fetal distress or hypoxia. Meconium can block the airways and cause breathing problems for the newborn, so suctioning the mouth and nose (or the trachea if needed) is important to prevent meconium aspiration syndrome.
Choice A is wrong because taking the mother’s vital signs every 15 minutes is not a specific intervention for meconium-stained amniotic fluid.
Vital signs should be monitored regularly during labor regardless of the fluid color.
Choice B is wrong because sending a specimen of the fluid to the laboratory for analysis is not a priority action.The color and consistency of the fluid can be observed by the nurse and documented.
The laboratory analysis will not change the immediate management of the newborn.
Choice D is wrong because preparing a slide of the fluid for fern testing is not relevant for meconium-stained amniotic fluid.
Fern testing is used to confirm the rupture of membranes by detecting a fern-like pattern of amniotic fluid under a microscope.It is not useful for assessing the presence or severity of meconium-stained amniotic fluid.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is choice C. Remind the patient that the nurse will stay with her during the examination.
This measure would help reduce the patient’s anxiety by providing emotional support and reassurance.
The patient may feel scared, embarrassed, or vulnerable during the pelvic examination, especially since she is young and pregnant.
Having a trusted person with her can help her cope with these feelings.
Choice A is wrong because it may imply that the examination will be painful and increase the patient’s anxiety.
Choice B is wrong because it may make the patient feel like she is not being treated as an individual and that her concerns are not valid.
Choice D is wrong because it may make the patient feel rushed or pressured and not allow her to ask questions or express her feelings.
Correct Answer is A
Explanation
The correct answer is choice A: “The discharge that you are describing is normal at this time.” This is because the client is experiencing lochia serosa, which is a brownish discharge that occurs from about day 4 to day 10 postpartum.
Lochia serosa is composed of old blood, serum, leukocytes, and tissue debris.
It indicates that the placental site is healing and the uterus is involuting.
Choice B is wrong because fever is a sign of infection, not normal lochia.
Choice C is wrong because ovulation usually does not resume until 6 weeks postpartum for nonbreastfeeding women and later for breastfeeding women.
Choice D is wrong because iron supplements do not affect lochia color or amount.
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