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Which of the following is the appropriate nursing care outcome for a client who suddenly develops anaphylactoid syndrome of pregnancy (ASP) during labor?

A.

Client will be infection free at discharge.

B.

Client will exhibit normal breathing function at discharge.

C.

Client will exhibit normal gastrointestinal function at discharge.

D.

Client will void without pain at discharge.

Answer and Explanation

The Correct Answer is B

Choice A rationale

While infection prevention is vital, ensuring breathing function is more critical after ASP.

 

Choice B rationale

ASP affects the respiratory system severely; thus, restoring normal breathing is a primary goal.

 

Choice C rationale

Gastrointestinal function is less immediately affected by ASP compared to respiratory issues.

 

Choice D rationale

Voiding without pain is important, but respiratory stability takes precedence.


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Correct Answer is C

Explanation

Choice A rationale

The hemoglobin level of 11.6 g/dL is within the normal range for a pregnant woman. While placenta previa requires monitoring, it is not immediately life-threatening.

Choice B rationale

Type 2 diabetes mellitus requires regular monitoring and management, but a single fasting blood glucose level does not indicate an immediate emergency unless it is extremely high or low.

Choice C rationale

Partial placental abruption can lead to significant complications for both the mother and fetus, including hemorrhage and fetal distress, making it the priority for immediate assessment.

Choice D rationale

An Rh-negative status and a recent cerclage placement are important for ongoing monitoring but do not present an immediate life-threatening condition that demands the first assessment.

Correct Answer is A

Explanation

Choice A rationale

Methylergonovine (Methergine) is used to manage postpartum hemorrhage by stimulating uterine contractions. It is especially useful in cases like this where rapid uterine tone is needed.

Choice B rationale

Magnesium sulfate is used to prevent seizures in preeclamptic patients, not to manage postpartum hemorrhage. This choice is incorrect in this context.

Choice C rationale

Carboprost-tromethamine (Hemabate) is also used for treating postpartum hemorrhage but is typically a secondary option to methylergonovine and may have more side effects.

Choice D rationale

Fresh frozen plasma (FFP) is used to replace clotting factors in cases of coagulopathy, not as a primary intervention for postpartum hemorrhage in this patient.

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