An antenatal client at 32 weeks' gestation has been admitted to the hospital with premature rupture of membranes. She is not exhibiting any signs of labor. What is the priority nursing intervention for this client?
Administer parental antibiotics
Prepare for delivery
Provide emotional support
Assess cervical dilation every 6 hours
The Correct Answer is A
A. Administer parenteral antibiotics. The primary concern with premature rupture of membranes (PROM) is the risk of infection, so administering antibiotics is crucial to prevent infection in both the mother and fetus.
B. Prepare for delivery. Without signs of labor, the focus is on preventing infection and monitoring, not immediate delivery.
C. Provide emotional support. While important, the priority intervention is preventing infection.
D. Assess cervical dilation every 6 hours. Routine cervical checks are not typically necessary unless there are signs of labor or other indications.
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Related Questions
Correct Answer is A
Explanation
A. slight yellow vaginal discharge: Gonorrhea often presents with a purulent or yellowish vaginal discharge in females. It is one of the common symptoms along with pelvic pain and dysuria.
B. Decrease in urinary frequency: Gonorrhea can actually increase urinary frequency or cause dysuria. A decrease in frequency is not typical for gonorrhea.
C. frothy, white vaginal discharge: This is more characteristic of Trichomoniasis, not gonorrhea. Gonorrhea usually presents with a thicker, more purulent discharge.
D. low grade fever for three (3) days: While fever can be associated with many infections, it is not a common primary symptom of gonorrhea in the absence of more specific symptoms like discharge or pelvic pain.
Correct Answer is D
Explanation
A. Sole creases on heels. Sole creases are a sign of maturity and are usually present in full-term infants, not preterm.
B. Ruddy skin color. This is more common in infants with polycythemia or those who are small for gestational age, not specifically linked to prematurity.
C. Flexion of all four extremities. Premature infants typically have less muscle tone and may exhibit less flexion, often appearing more limp or having extended extremities.
D. Scant amount of vernix caseosa. Premature infants typically have more vernix caseosa, which protects their delicate skin in utero. The amount decreases closer to full term, but at 31 weeks, there may still be a moderate amount.
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