Test question re: PROM

[guest563546]

I just wanted professional opinions. This one is bothering myself and some classmates. Test question reads: A patient who is at 30 weeks presents to the clinic with PROM. Select the appropriate nursing diagnosis for the patient:

a. Ineffective individual coping

b. Fluid volume, deficient

c. Infection

We have been advised that when taking tests we are not to assume, we should use the information given. I chose ineffective coping because that is listed in the book. The correct answer, according to our instructor, is infection. We advised her we didn't have any indicators of infection (a diagnosis, elevated temp, labs, etc.) and she told us that infection is the most common cause so we should have assumed that was the cause. We told her we would have chosen risk for infection had it been available but she is adamant. And I'm not one of those people who whines every time she gets an answer wrong, and I don't think my instructor is an idiot/jerk/out to get me/Satan. I'm not quite sure WHY this is bothering me, but it is. I'm an LPN bridging to RN so I understand that sometimes answers can be crazy and we have to think outside the box. I think it's the part about how we should assume that bothers me. I don't want rainbows up my skirt, just some rationales. Thanks in advance!

[klone, MSN, RN]

I agree with you that infection is not an appropriate dx based only on the patient presenting with PROM (and actually, it would be considered PPROM, not PROM). RISK FOR infection would be the most appropriate, says this OB nurse of over a decade.

[lavenderskies, BSN]

There's actually not enough info in the question to clearly assign any of the answers but I'd go with infection based on the idea that it's the greatest risk. And actually it would be risk of just as Klone stated.

[loving2024, BSN, RN]

Well, I think infection is the appropriate answer because amniotic fluid protect the fetus from bacteria and also cushion the fetus from compressing the umbilical cord. However, when amniotic fluid ruptures, it provides a path for bacteria to enter the womb.

[klone, MSN, RN]

Well, I think infection is the appropriate answer because amniotic fluid protect the fetus from bacteria and also cushion the fetus from compressing the umbilical cord. However, when amniotic fluid ruptures, it provides a path for bacteria to enter the womb.

Right, but she does not have an infection YET. She may not ever develop one. So giving her a dx of infection would not be accurate.

[nevergiveup2016]

Ok so I instantly would have picked infection. Only because the other answers seem like you're reading too into it. I do understand though that there are no signs of infection so she really should have put risk for. However currently being in nursing school I've got some talks from nursing instructors that say well you would assume because in the NCLEX/testing world everything is perfect... which is a bunch bull.... But i think your argument is valid but I doubt the instructor will change her view point.

[LibraSunCNM, BSN, MSN, CNM]

Yes, that's an extremely poorly-worded question. The professor may have realized that she should have written "risk for infection" as the answer choice, but not wanted to admit she was wrong.

[babyNP., APRN]

Your teacher is wrong, plain and simple. I would have chosen "fluid volume, deficient," although it doesn't specify which type of fluid volume (I'm assuming it is supposed to refer to amniotic fluid).

There is a reason why we can't choose "sepsis" for ICD coding but rather choose "observation of infection" when it is likely to have occurred/to occur, but has not been confirmed yet.

[Here.I.Stand, BSN, RN]

Not an OB nurse, but I would agree that risk for infection would be an appropriate NDx. The question doesn't indicate the pt's WBC count, fever, elevated HR/low BP, anything indicative of active infection.

The question doesn't indicate how she's coping one way or another, nor does it give any indication of hypovolemia (loss of amniotic fluid won't affect the woman's hemodynamics. Giving her an IV fluid bolus won't improve correct the problem, as if it would if she were hypovolemic). So those aren't good choices either.

[la_chica_suerte85, BSN, RN]

While I agree that it's a really bizarre question in terms of wording (yeah, it's PPROM, not PROM) but I think the reason it is infection and not risk for infection is because a PPROM may occur d/t inflammatory or infectious processes that may already be present. Medscape: Medscape Access

Hence, why you're instructor is honing in on just infection as opposed to risk for infection. But, infection on it's own is a medical diagnosis and not a nursing diagnosis, so, essentially, we're all over the place here.

[Elvish, BSN, DNP, RN, NP]

Risk for infection.

Wouldn't choose fluid volume deficit because that nursing dx implies systemic fluid volume deficit, not amniotic fluid. Wouldn't choose ineffective coping, because there's no evidence that she isn't coping well. I've taken care of PPROMers who are hospitalized for up to 8-10 weeks and some of them cope phenomenally with a situation that sucks overall. Wouldn't want to choose infection because (as others have mentioned) there's no evidence that she's currently infected. Some people are ruptured for weeks at a time before infection develops and we have to induce them.

However, given the bad choices you have in this question, I'd still have gone with infection, because even if we assume that she's only at risk for all 3, infection is the most immediately life-threatening.

[gonzo1, ASN, RN]

I feel your pain, very poorly worded question, with bad choice of answers. That said, you are going to be encountering many of these during your education and while testing for NCLEX.