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.
A nurse notes that a postpartum client has been agitated, confused, and unresponsive to verbal cues. According to the MEWS criteria, what is the likely priority action?
A. Administer IV fluids to improve hemodynamic stability
B. Check blood glucose to rule out hypoglycemia
C. Notify the provider and prepare for immediate intervention
D. Increase oxygen delivery to improve perfusion
C. Notify the provider and prepare for immediate intervention
Rationale: Agitation, confusion, or unresponsiveness are severe warning signs requiring prompt provider notification to address potential neurologic or systemic compromise.
A postpartum client has an FHR consistently above 160 bpm during fetal monitoring. What maternal condition should the nurse suspect based on MEWS criteria?
A. Hypoglycemia
B. Postpartum hemorrhage
C. Amniotic fluid embolism
D. Maternal infection or fever
D. Maternal infection or fever
Rationale: Sustained fetal tachycardia (>160 bpm) is often associated with maternal fever or infection, requiring further evaluation and potential antibiotic therapy.
A client’s urine output over the past two hours is 30 mL/hour. Which MEWS criterion does this meet, and what is the appropriate intervention?
A. This meets the oliguria criterion; notify the provider and assess for potential sepsis or hypovolemia
B. This meets the renal failure criterion; increase IV fluids to improve urine output
C. This meets the dehydration criterion; encourage oral fluids and reassess
D. This meets no MEWS criteria; continue monitoring as usual
A. This meets the oliguria criterion; notify the provider and assess for potential sepsis or hypovolemia
Rationale: Urine output less than 35 mL/hour over 2 hours is an early warning sign of renal compromise and warrants immediate provider notification and assessment.
A nurse is educating a pregnant client with a history of preterm labor about maternal sepsis prevention. Which statement by the client indicates effective understanding?
A. “If my water breaks, I should wait at least 24 hours before contacting my healthcare provider.”
B. “Maintaining good hygiene and reporting any signs of infection are important to prevent complications.”
C. “I only need to be concerned about infections during the postpartum period.”
D. “Multiple vaginal exams during labor reduce the risk of infection.”
B. “Maintaining good hygiene and reporting any signs of infection are important to prevent complications.”
Rationale: Good hygiene and early reporting of infection signs are key measures in preventing maternal sepsis, especially in high-risk pregnancies.
Which intervention is the priority for a client with prolonged rupture of membranes to prevent maternal sepsis?
A. Administering a corticosteroid to promote fetal lung maturity
B. Starting prophylactic antibiotics as prescribed
C. Monitoring fetal heart rate every four hours
D. Encouraging ambulation to reduce the risk of blood clots
B. Starting prophylactic antibiotics as prescribed
Rationale: Prophylactic antibiotics are critical in preventing infection in cases of prolonged rupture of membranes, a major risk factor for maternal sepsis.
A postpartum client presents with a retained placenta. Which nursing intervention is the most effective in preventing maternal sepsis?
A. Monitoring for signs of infection and notifying the provider promptly
B. Administering oxytocin to stimulate uterine contractions
C. Advising the client to breastfeed frequently to enhance uterine involution
D. Encouraging oral hydration to promote renal perfusion
A. Monitoring for signs of infection and notifying the provider promptly
Rationale: Retained placenta is a significant risk factor for maternal sepsis. Early detection of infection signs and timely intervention are crucial for prevention.
What is the nurse’s priority when caring for a client with preeclampsia who is at risk for maternal sepsis?
A. Monitoring blood pressure every hour
B. Preparing the client for an emergency cesarean delivery
C. Administering magnesium sulfate to prevent eclampsia
D. Teaching the client about early signs of infection, such as fever or foul-smelling discharge
D. Teaching the client about early signs of infection, such as fever or foul-smelling discharge
Rationale: Education on recognizing early signs of infection empowers the client to seek timely care, reducing the risk of sepsis in high-risk conditions like preeclampsia.
A postpartum client with suspected sepsis is receiving isotonic crystalloids for fluid resuscitation. Which finding indicates the need to escalate care with vasopressors?
A. MAP remains <65 mmHg after fluid resuscitation
B. Heart rate decreases to 60 bpm after fluid administration
C. Respiratory rate is 16 breaths per minute
D. Urine output exceeds 1 mL/kg/hour
A. MAP remains <65 mmHg after fluid resuscitation
Rationale: Persistent hypotension despite fluid resuscitation indicates the need for vasopressors to maintain adequate perfusion.
When managing a client with maternal sepsis, the nurse monitors lactate levels. Which finding requires immediate intervention?
A. Lactate level of 1.8 mmol/L
B. Lactate level of 2.5 mmol/L
C. Lactate level of 3.9 mmol/L
D. Lactate level of 4.5 mmol/L
D. Lactate level of 4.5 mmol/L
Rationale: Lactate levels >4 mmol/L suggest lactic acidemia and tissue hypoxia, requiring urgent intervention.
A nurse is preparing to administer norepinephrine to a client with maternal sepsis. What is the priority nursing action before initiating the medication?
A. Obtain a baseline lactate level
B. Place an arterial line for blood pressure monitoring
C. Assess urine output via a Foley catheter
D. Administer oxygen to maintain SpO2 >95%
B. Place an arterial line for blood pressure monitoring
Rationale: Arterial lines are required for accurate monitoring of blood pressure when vasopressors like norepinephrine are used.
Which assessment finding would prompt the nurse to prepare blood products for a client with maternal sepsis?
A. SpO2 of 97%
B. Coagulopathy detected on lab results
C. MAP of 70 mmHg after fluid resuscitation
D. Urine output of 0.8 mL/kg/hour
B. Coagulopathy detected on lab results
Rationale: Coagulopathies in maternal sepsis may require blood products to restore clotting function.
A nurse is monitoring a postpartum client with suspected sepsis. Which bedside assessment finding is most concerning?
A. Urine output of 0.4 mL/kg/hour over 2 hours
B. Mental status changes, such as confusion
C. SpO2 of 96% on room air
D. Heart rate of 95 bpm
A. Urine output of 0.4 mL/kg/hour over 2 hours
Rationale: Oliguria (<0.5 mL/kg/hour) is a sign of poor perfusion and may indicate worsening sepsis.
In a client with maternal sepsis, which intervention is most appropriate for maintaining oxygen saturation >95%?
A. Encourage deep breathing exercises
B. Administer oxygen via nasal cannula or face mask as prescribed
C. Elevate the head of the bed to 15 degrees
D. Restrict fluid intake to prevent pulmonary edema
B. Administer oxygen via nasal cannula or face mask as prescribed
Rationale: Supplemental oxygen is crucial to maintain adequate tissue oxygenation in sepsis.
A nurse notes a lactate level of 3.2 mmol/L in a client with maternal sepsis. What action should the nurse prioritize?
A. Increase oxygen flow rate to 10 L/min
B. Administer norepinephrine immediately
C. Notify the provider to prepare for ICU transfer
D. Continue fluid resuscitation and monitor response
D. Continue fluid resuscitation and monitor response
Rationale: Lactate levels >2 mmol/L indicate tissue hypoperfusion; fluid resuscitation is the first-line intervention.
Which nursing action is critical for ensuring accurate monitoring of urine output in a client with maternal sepsis?
A. Instruct the client to use a bedside commode for voiding
B. Place a Foley catheter with a urometer for hourly measurements
C. Document voiding frequency and estimated volumes
D. Encourage fluid intake to increase urine production
B. Place a Foley catheter with a urometer for hourly measurements
Rationale: Accurate urine output measurement via a Foley catheter with a urometer is essential to assess kidney function and perfusion.
A nurse is reviewing the laboratory results of a postpartum client with suspected sepsis. Which finding is most indicative of an active infection?
A. Increased platelet count
B. Decreased creatinine levels
C. Elevated percentage of immature neutrophils (bands)
D. Normal bilirubin level
C. Elevated percentage of immature neutrophils
Rationale: An increase in immature neutrophils (bands) is a hallmark of an active infection, indicating a left shift in the differential.
Why is it important to obtain blood cultures before initiating antibiotics in maternal sepsis management?
A. To avoid contamination of the blood samples
B. To reduce the risk of drug resistance
C. To monitor the patient’s lactate levels
D. To identify the specific pathogen causing the infection
D. To identify the specific pathogen causing the infection
Rationale: Blood cultures help determine the causative organism and guide targeted antibiotic therapy.
Which imaging modality is most appropriate for assessing a suspected uterine infection in a client with maternal sepsis?
A. MRI
B. Chest X-ray
C. Ultrasound
D. CT scan
C. Ultrasound
Rationale: Ultrasound is the preferred initial imaging technique for identifying uterine infections, such as retained products of conception.
A client with suspected chorioamnionitis has a uterine culture ordered. What is the primary nursing consideration for this diagnostic test?
A. Administer a dose of broad-spectrum antibiotics prior to obtaining the culture
B. Explain the purpose of the test to the client and obtain consent
C. Ensure the specimen is collected in a sterile manner
D. Delay the test until blood culture results are available
C. Ensure the specimen is collected in a sterile manner
Rationale: Uterine cultures must be obtained under sterile conditions to prevent contamination and ensure accurate results.
What is the significance of measuring lactate levels in a client with maternal sepsis?
A. Indicates renal function and electrolyte balance
B. Reflects tissue hypoperfusion and potential hypoxia
C. Confirms the presence of coagulopathies
D. Identifies specific pathogens causing the infection
B. Reflects tissue hypoperfusion and potential hypoxia
Rationale: Elevated lactate levels indicate tissue hypoperfusion and help assess the severity of sepsis.
Which diagnostic test is essential to evaluate respiratory function in a client with maternal sepsis and suspected hypoxemia?
A. Urinalysis
B. Arterial blood gases (ABG)
C. Blood cultures
D. Coagulation panel
B. Arterial blood gases (ABG)
Rationale: ABG testing evaluates oxygenation, carbon dioxide levels, and acid-base balance in clients with suspected hypoxemia.
A postpartum client with maternal sepsis has a coagulation panel ordered. Which abnormal finding requires immediate intervention?
A. PT of 12 seconds
B. PTT of 30 seconds
C. INR of 2.5
D. Platelet count of 250,000/mm³
C. INR of 2.5
Rationale: An INR >1.1 in a non-anticoagulated client suggests a coagulopathy and increased risk of bleeding, requiring prompt intervention.
What is the primary purpose of performing a comprehensive metabolic panel (CMP) in maternal sepsis?
A. To identify electrolyte imbalances and organ dysfunction
B. To detect coagulopathy and platelet abnormalities
C. To measure arterial oxygen saturation
D. To determine the source of infection
A. To identify electrolyte imbalances and organ dysfunction
Rationale: The CMP provides information about kidney and liver function, electrolyte status, and metabolic abnormalities associated with sepsis.
A postpartum client with maternal sepsis undergoes a chest X-ray. What is the most likely reason for ordering this test?
A. To confirm chorioamnionitis
B. To identify retained products of conception
C. To rule out a pulmonary infection as the source of sepsis
D. To assess oxygen saturation levels
C. To rule out a pulmonary infection as the source of sepsis
Rationale: A chest X-ray is used to detect pneumonia or other pulmonary infections that may be contributing to sepsis.
A postpartum client diagnosed with maternal sepsis is prescribed gentamicin and ampicillin. What is the rationale for using these two antibiotics together?
A. To prevent adverse drug interactions
B. To broaden the spectrum of coverage for likely pathogens
C. To reduce the risk of antibiotic resistance
D. To target fungal infections commonly associated with sepsis
B. To broaden the spectrum of coverage for likely pathogens
Rationale: Gentamicin (an aminoglycoside) and ampicillin (a beta-lactam antibiotic) are often combined to cover a wide range of gram-positive, gram-negative, and anaerobic bacteria responsible for maternal sepsis.
A client with maternal sepsis is receiving isotonic crystalloids as part of fluid resuscitation. What is the goal of this intervention?
A. To restore intravascular volume and improve tissue perfusion
B. To correct acidosis caused by elevated lactate levels
C. To lower elevated blood pressure associated with sepsis
D. To reduce coagulation abnormalities
A. To restore intravascular volume and improve tissue perfusion
Rationale: Rapid fluid resuscitation with isotonic crystalloids (e.g., normal saline or lactated Ringer’s) helps improve circulation and tissue perfusion in septic patients.
What laboratory value should be closely monitored when administering gentamicin for maternal sepsis?
A. Platelet count
B. Serum creatinine
C. Prothrombin time (PT)
D. Blood glucose
B. Serum creatinine
Rationale: Gentamicin is nephrotoxic, so renal function must be monitored to avoid kidney damage.
Which of the following medications would be most appropriate if a client with maternal sepsis develops coagulopathy and active bleeding?
A. Norepinephrine
B. Ampicillin
C. Fresh frozen plasma
D. Gentamicin
C. Fresh frozen plasma
Rationale: Fresh frozen plasma is administered to correct coagulopathy and replenish clotting factors in clients with active bleeding.
Which lab value is most likely elevated in pregnant clients with sepsis due to normal physiological changes during pregnancy?
A. Hemoglobin
B. White blood cell (WBC) count
C. Platelet count
D. Creatinine clearance
B. White blood cell (WBC) count
Rationale: During pregnancy, WBC counts are naturally elevated, especially in the third trimester, which can complicate the diagnosis of sepsis by masking early signs of infection.
A pregnant client with sepsis has a serum creatinine of 1.1 mg/dL. How should this value be interpreted compared to a non-pregnant client?
A. It is normal for both pregnant and non-pregnant clients
B. It indicates impaired renal function in a pregnant client
C. It is expected due to increased glomerular filtration rate (GFR) in pregnancy
D. It reflects dehydration rather than sepsiss
B. It indicates impaired renal function in a pregnant client
Rationale: Pregnancy typically lowers serum creatinine due to increased GFR. A value of 1.1 mg/dL may indicate renal impairment in a pregnant client, even though it may be normal in a non-pregnant client.
When interpreting coagulation studies in a pregnant client with suspected sepsis, what should the nurse consider?
A. Fibrinogen levels are naturally lower in pregnancy
B. Platelet counts are always higher in pregnant clients
C. Pregnancy increases the risk of disseminated intravascular coagulation (DIC)
D. Coagulation studies are unaffected by pregnancy
C. Pregnancy increases the risk of disseminated intravascular coagulation (DIC)
Rationale: Pregnancy is a hypercoagulable state, which increases the risk of DIC in sepsis or other complications such as placental abruption or preeclampsia.
Which finding is more likely in non-pregnant clients with sepsis compared to pregnant clients?
A. Elevated bilirubin levels
B. Decreased platelet counts
C. Higher oxygen saturation
D. Lower white blood cell counts
A. Elevated bilirubin levels
Rationale: Non-pregnant clients may show elevated bilirubin more frequently as a sign of liver dysfunction, while pregnant clients might exhibit different lab markers depending on pregnancy-related conditions like HELLP syndrome.
How does the interpretation of arterial blood gas (ABG) results differ in pregnant versus non-pregnant clients with sepsis?
A. Pregnant clients have a naturally lower PaCO2
B. Pregnant clients have an elevated HCO3- due to metabolic alkalosis
C. Non-pregnant clients typically have a higher oxygen demand
D. Non-pregnant clients have a naturally lower pH level
A. Pregnant clients have a naturally lower PaCO2
Rationale: During pregnancy, a lower PaCO2 (around 30 mmHg) is normal due to hyperventilation from increased progesterone levels, which must be considered when interpreting ABGs in septic pregnant clients.
