Maternal Sepsis Flashcards
Which of the following antepartum conditions places a woman at the greatest risk for developing maternal sepsis?
A. Polyhydramnios
B. Preeclampsia
C. Gestational diabetes
D. Oligohydramnios
B. Preeclampsia
Rationale: Preeclampsia compromises maternal immune responses and vascular integrity, increasing the risk of infection and sepsis.
A client with PPROM is at risk for which of the following complications that could lead to maternal sepsis?
A. Chorioamnionitis
B. Placental abruption
C. Precipitous labor
D. Hyperemesis gravidarum
A. Chorioamnionitis
Rationale: PPROM allows pathogens to ascend into the uterus, significantly increasing the risk of chorioamnionitis and maternal sepsis.
During labor, multiple vaginal exams can increase the risk for maternal sepsis by:
A. Causing uterine hyperstimulation
B. Delaying the progression of labor
C. Reducing maternal blood flow to the uterus
D. Introducing pathogens into the sterile environment
D. Introducing pathogens into the sterile environment
Rationale: Repeated vaginal exams increase the risk of introducing bacteria, especially in the presence of ruptured membranes.
Which intrapartum condition is most likely to contribute to maternal sepsis?
A. Use of an epidural
B. Prolonged second stage of labor
C. Spontaneous rupture of membranes at term
D. Delivery of a macrosomic infant
B. Prolonged second stage of labor
Rationale: Prolonged labor increases the risk of infection, especially when combined with other risk factors like PROM or multiple vaginal exams.
A nurse is assessing a postpartum woman who had a vacuum-assisted vaginal delivery. Which finding should be immediately reported as a potential indicator of maternal sepsis?
A. Elevated blood pressure and headache
B. Scant vaginal bleeding and dizziness
C. Firm uterus and tachycardia
D. Foul-smelling lochia and fever
D. Foul-smelling lochia and fever
Rationale: These findings suggest endometritis or another infection, which could lead to maternal sepsis if untreated.
Why is IVF technology considered a risk factor for maternal sepsis during the antepartum period?
A. It increases the likelihood of chromosomal abnormalities.
B. It is associated with higher rates of multiple gestation.
C. It causes uterine overdistension.
D. It reduces maternal immune function.
B. It is associated with higher rates of multiple gestation.
Rationale: Multiple gestation increases the risk of complications such as preterm labor, chorioamnionitis, and PPROM, all of which heighten the risk of maternal sepsis.
Which postpartum condition most commonly predisposes a client to maternal sepsis?
A. Retained placenta/products
B. Episiotomy
C. Breast engorgement
D. Delayed milk production
A. Retained placenta/products
Rationale: Retained placental tissue can act as a site for bacterial growth, increasing the risk of infection and sepsis.
A client undergoing a cesarean section is at increased risk for maternal sepsis due to:
A. Delayed labor progression
B. Uterine hyperstimulation
C. Potential wound infection
D. Increased amniotic fluid levels
C. Potential wound infection
Rationale: Surgical intervention increases the risk of infection at the incision site, which may lead to maternal sepsis.
In postpartum clients, endometritis most commonly results from:
A. Excessive blood loss during delivery
B. Ascending bacterial infection from the vagina
C. Prolonged breastfeeding sessions
D. Overuse of antibiotics during labor
B. Ascending bacterial infection from the vagina
Rationale: Endometritis is usually caused by bacteria traveling from the lower genital tract to the endometrium, especially after prolonged labor or cesarean delivery.
A client presents with pyelonephritis during pregnancy. Which complication should the nurse monitor for in relation to maternal sepsis?
A. Preterm labor
B. Fetal macrosomia
C. Shoulder dystocia
D. Polyhydramnios
A. Preterm labor
Rationale: Pyelonephritis can trigger systemic inflammation, increasing the risk of preterm labor and subsequent maternal sepsis.
Which intervention is most critical in preventing maternal sepsis in a client with prolonged rupture of membranes (PROM)?
A. Administering IV antibiotics prophylactically
B. Performing immediate cesarean delivery
C. Encouraging ambulation during labor
D. Using a fetal scalp electrode
A. Administering IV antibiotics prophylactically
Rationale: Antibiotics can reduce the risk of ascending infections in cases of prolonged rupture of membranes.
Increased vaginal exams during labor are contraindicated in clients with:
A. A history of hypertension
B. Premature rupture of membranes (PROM)
C. Prolonged third stage of labor
D. Gestational diabetes
B. Premature rupture of membranes (PROM)
Rationale: Frequent vaginal exams increase the risk of infection when the protective barrier of the amniotic sac is no longer intact.
A nurse is caring for a postpartum client with suspected maternal sepsis. What is the primary goal of treatment within the first hour of recognition?
A. Achieve a MAP > 65 mmHg
B. Obtain a central venous oxygenation (ScvO2) reading
C. Perform fluid resuscitation
D. Administer appropriate antibiotics
D. Administer appropriate antibiotics
Rationale: Immediate antibiotic therapy is crucial to reduce the progression of sepsis and prevent morbidity and mortality.
Why is achieving a MAP > 65 mmHg critical in the management of maternal sepsis?
A. It ensures adequate tissue perfusion.
B. It reduces fluid retention.
C. It eliminates the source of infection.
D. It prevents respiratory complications.
A. It ensures adequate tissue perfusion.
Rationale: Maintaining a MAP > 65 mmHg is essential to ensure blood flow to vital organs and prevent organ failure.
A postpartum client is diagnosed with septic shock. The physician orders Gentamicin and Ampicillin. Why are these antibiotics typically used in maternal sepsis?
A. They are narrow-spectrum agents.
B. They do not require renal function monitoring.
C. They cover 90% of obstetric sepsis pathogens.
D. They reduce systemic inflammation.
C. They cover 90% of obstetric sepsis pathogens.
Rationale: Gentamicin and Ampicillin are broad-spectrum antibiotics effective against most common pathogens causing obstetric infections.
A client with maternal sepsis has a central venous oxygenation (ScvO2) level of 60%. What does this indicate?
A. Adequate tissue oxygenation
B. Increased oxygen delivery
C. Inadequate oxygen extraction at the tissue level
D. Reduced cardiac output
C. Inadequate oxygen extraction at the tissue level
Rationale: An ScvO2 level below 70% suggests impaired oxygenation at the tissue level, necessitating interventions such as fluid resuscitation or inotropes.
In the treatment of maternal sepsis, why is it important to normalize lactate levels?
A. It reduces the risk of coagulopathy.
B. It indicates improved tissue perfusion.
C. It prevents fluid overload.
D. It minimizes antibiotic resistance.
B. It indicates improved tissue perfusion.
Rationale: Elevated lactate levels are a marker of tissue hypoxia, and normalization indicates restored tissue oxygenation.
Which fluid resuscitation goal is critical in managing maternal sepsis?
A. Improving left ventricular function
B. Increasing urine output to > 1.0 mL/kg/hour
C. Correcting electrolyte imbalances
D. Increasing lactate production
A. Improving left ventricular function
Rationale: Fluid resuscitation enhances cardiac preload and output, thereby improving left ventricular function and overall tissue perfusion.
What is the primary purpose of identifying the source of infection in maternal sepsis?
A. To guide targeted antibiotic therapy
B. To reduce lactate levels
C. To prevent hypotension
D. To normalize oxygen saturation
A. To guide targeted antibiotic therapy
Rationale: Identifying the source of infection allows for appropriate interventions and targeted antibiotic treatment.
A client with maternal sepsis is receiving fluid resuscitation. Which finding indicates that the treatment is effective?
A. Lactate level increases from 2.5 mmol/L to 3.0 mmol/L
B. ScvO2 decreases from 75% to 68%
C. MAP decreases to 60 mmHg
D. Urine output increases to 35 mL/hour
D. Urine output increases to 35 mL/hour
Rationale: Increased urine output indicates improved renal perfusion and effective fluid resuscitation in sepsis management.
A nurse is monitoring a postpartum client and notes a blood pressure of 165/105 mmHg and a heart rate of 125 bpm. Based on the Maternal Early Warning Signs (MEWS) criteria, what is the priority intervention?
A. Increase IV fluid rate to manage hypotension
B. Notify the provider of hypertensive and tachycardic findings
C. Administer oxygen to improve saturation
D. Perform a non-stress test to assess fetal well-being
B. Notify the provider of hypertensive and tachycardic findings
Rationale: Both systolic BP >160 mmHg and HR >120 bpm are critical findings requiring immediate provider notification and intervention to prevent complications.
Which finding in a postpartum client meets the MEWS criteria for urgent evaluation?
A. SpO2 of 93%
B. RR of 16 breaths per minute
C. Urine output of 50 mL over 2 hours
D. Fetal heart rate of 145 bpm (sustained)
A. SpO2 of 93%
Rationale: SpO2 <95% is an early warning sign indicating potential respiratory compromise and warrants further assessment.
A client with preeclampsia reports a persistent headache and shortness of breath. What is the nurse’s priority intervention?
A. Increase oral fluid intake to manage oliguria
B. Administer antihypertensive medication immediately
C. Notify the healthcare provider and prepare for further evaluation
D. Perform fundal massage to prevent uterine atony
C. Notify the healthcare provider and prepare for further evaluation
Rationale: Persistent headache and shortness of breath are serious symptoms of preeclampsia that require urgent evaluation to prevent progression to eclampsia or pulmonary edema.
What maternal heart rate value would meet the MEWS criteria for further evaluation?
A. 55 bpm
B. 85 bpm
C. 100 bpm
D. 125 bpm
D. 125 bpm
Rationale: A heart rate >120 bpm falls within the MEWS criteria for tachycardia, indicating potential maternal instability and necessitating further assessment.