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A nurse in Labor and Delivery is caring for a client who just experienced SROM (spontaneous rupture of membranes) after her epidural. The client immediately states she is short of breath. The nurse lays the patient back and places oxygen on her when the client goes into complete cardiorespiratory failure.
The nurse should recognize that this client is experiencing which of the following obstetrical emergencies?

A.

Anaphylactoid syndrome of pregnancy.

B.

Abruptio placentae.

C.

Uterine rupture.

D.

Disseminated intravascular coagulation.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Anaphylactoid syndrome of pregnancy (also known as amniotic fluid embolism) occurs when amniotic fluid, fetal cells, hair, or other debris enter the mother's bloodstream, triggering

a serious reaction. It can cause sudden shortness of breath, cardiovascular collapse, and other severe symptoms immediately after a rupture of membranes and is a rare but critical

obstetrical emergency.

 

Choice B rationale

Abruptio placentae involves the premature separation of the placenta from the uterine wall, which leads to bleeding and potential fetal and maternal distress. However, it does not

typically present with sudden cardiorespiratory collapse or shortness of breath immediately following membrane rupture.

 

Choice C rationale

Uterine rupture refers to a tear in the wall of the uterus, usually due to trauma, labor stress, or previous surgical scars. While it is a severe condition, it usually presents with

abdominal pain, vaginal bleeding, and fetal distress rather than sudden respiratory failure.

 

Choice D rationale

Disseminated intravascular coagulation (DIC) is a condition affecting blood clotting processes, often secondary to other conditions like severe preeclampsia, sepsis, or trauma. It

generally presents with bleeding and clotting issues but not sudden respiratory or cardiovascular collapse.


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View Related questions

Correct Answer is ["A","B","C","F"]

Explanation

Choice A rationale:

A postpartum temperature of 100.4°F (38.0°C) or higher may indicate an infection. Infections can occur after delivery, particularly if there was a manual extraction of the placenta, as in

this case. Close monitoring and further assessment are necessary to ensure the client does not develop sepsis or other complications.

Choice B rationale:

Fundal tone should be firm and well-contracted to prevent excessive bleeding postpartum. A boggy, midline fundus suggests that the uterus is not contracting effectively, increasing the

risk for postpartum hemorrhage. This requires immediate attention and intervention to ensure adequate uterine tone and control bleeding.

Choice C rationale:

Lochia should be monitored for quantity, color, and the presence of clots. Heavy lochia with small clots indicates that the client may be experiencing postpartum hemorrhage, which is a

significant concern. This can be related to uterine atony, retained placental fragments, or coagulopathies and warrants prompt evaluation and intervention.

Choice D rationale:

A respiratory rate of 17/min is within the normal adult range (12-20/min) and does not require follow-up. There are no signs of respiratory distress or abnormalities in this case, indicating

that the client's respiratory status is stable and does not necessitate further evaluation.

Choice E rationale:

A white blood cell count of 12,000/mm³ is within the expected range for postpartum women, where normal values can be elevated due to physiological stress and inflammation from

delivery. This level does not indicate infection or pathology and does not require follow-up in the context provided.

Choice F rationale:

Blood pressure of 144/92 mmHg is elevated and concerning, particularly in a postpartum client with a history of chronic hypertension and gestational diabetes. This could signal

postpartum preeclampsia or other hypertensive disorders, requiring careful monitoring and management to prevent complications like seizures, stroke, or organ damage.

Correct Answer is A

Explanation

Choice A rationale

A newborn who is 26 hours post-delivery and has had no urine output needs immediate attention. Lack of urine output for over 24 hours may indicate dehydration or renal issues. Immediate medical evaluation is required to identify underlying conditions and prevent complications such as acute kidney injury or sepsis.

Choice B rationale

Acrocyanosis, characterized by blueish discoloration of the extremities, is common in newborns during the first 24-48 hours of life and usually resolves on its own. It occurs due to immature blood circulation and is generally not a cause for concern.

Choice C rationale

Failure to pass meconium within the first 24 hours can be a sign of conditions like Hirschsprung's disease or cystic fibrosis, but it is not as immediately concerning as anuria (no urine output). Monitoring and further evaluation are necessary, but it does not require urgent provider notification.

Choice D rationale

A blood glucose level of 50 mg/dL in a newborn is within the lower limit of normal. While it's important to monitor, it does not necessitate immediate provider notification unless it continues to drop or other symptoms arise.

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