A woman who is 28 weeks pregnant is admitted to the high-risk OB ...

[skymedlock]

A woman who is 28 weeks pregnant is admitted to the high-risk OB unit with preterm premature rupture of the membranes. Four hours after admission, the nurse notes the following:
 
  temperature: 38.5 C (101.5 F), maternal pulse: 122 beats/minute, and white blood cell count: 23,000 mm3. Which action by the nurse takes priority?
  A.
  Document the findings and notify the health-care provider.
  B.
  Facilitate fern testing or Nitrazine testing on vaginal fluid.
  C.
  Prepare to administer a prn dose of acetaminophen (Tylenol).
  D.
  Reassure the woman that these are expected findings.

Question 2

A woman is admitted to the high-risk OB unit with the diagnosis of preterm labor. Orders include bedrest with continuous fetal monitoring, administration of magnesium sulfate (Sulfamag) and betamethasone (Celestone), and laboratory work.
 
  In reviewing the patient's record, the nurse notes a history of hypertension that is well controlled with nifedipine (Procardia) and diet-controlled diabetes mellitus type 2. Which action by the nurse is best?
  A.
  Assist the woman to choose appropriate food items from the menu.
  B.
  Call the physician to question the orders and document the conversation.
  C.
  Order a pressure-relieving mattress overlay and perform a skin assessment.
  D.
  Prepare to give the magnesium sulfate and betamethasone as ordered.

[blakcmamba]

Answer to Question 1

ANS: A
Delivery for a woman with premature rupture of membranes should be accomplished immediately for signs of maternal infection, advanced labor, vaginal bleeding, or nonreassuring fetal signs. This patient's vital signs and WBC indicate infection. The nurse should document the findings and notify the health-care provider so that arrangements can proceed. Fern testing or Nitrazine testing is done to help diagnose rupture of the membranes and is not needed at this time. Giving acetaminophen at this time is not a priority and may be contraindicated if the woman needs to be placed on NPO status.

Answer to Question 2

ANS: B
The combination of nifedipine and magnesium sulfate can cause sudden cardiac death. The nurse should contact the health-care provider to question the orders. The nurse should also document all aspects of this communication clearly. The woman may or may not need assistance in choosing food items appropriate for her diabetes. All patients need a full skin assessment and, depending on how long bedrest is anticipated, a pressure-relieving mattress overlay might be appropriate. The nurse should not give the medications without further clarification.