A. "Placenta previa usually results in a higher risk of maternal hypertension, while abruptio placentae is commonly associated with a low-risk pregnancy.
This is incorrect because abruptio placentae, not placenta previa, is associated with maternal hypertension (e.g., preeclampsia, chronic hypertension). Placenta previa is not related to blood pressure issues.

B. "Placenta previa is characterized by sudden onset of severe abdominal pain and uterine tenderness, while abruptio placentae is associated with painless bleeding."
This is incorrect because placenta previa presents with painless, bright red vaginal bleeding, while abruptio placentae causes sudden, severe abdominal pain, uterine tenderness, and possibly dark red bleeding.

C. "Placenta previa typically presents with severe pain and contractions, whereas abruptio placentae involves painless bleeding without contractions."
This is incorrect because placenta previa does not cause pain or contractions. In contrast, abruptio placentae often presents with painful contractions and uterine hypertonicity.

D. "Placenta previa involves the placenta partially or completely covering the cervix, whereas abruptio placentae involves the premature separation of the placenta from the uterine wall."
Placenta previa occurs when the placenta covers the cervix (partial or complete), leading to bleeding. Abruptio placentae occurs when the placenta prematurely separates from the uterine wall, which can lead to hemorrhage and fetal distress.

A. "The placenta is the site of gas exchange for the fetus."
This is correct because the placenta facilitates oxygen and carbon dioxide exchange between maternal and fetal circulation without direct blood mixing.
B. "The umbilical arteries carry deoxygenated blood from the fetus to the placenta."
This is correct because the two umbilical arteries carry deoxygenated blood from the fetus to the placenta, where gas exchange occurs.
C. "The fetal heart pumps blood to both the placenta and the developing organs."
This is correct because the fetal heart pumps oxygenated blood to its developing organs and sends deoxygenated blood to the placenta for gas exchange.
D. "Maternal and fetal blood mix to allow for nutrient and oxygen exchange."
This is incorrect because maternal and fetal blood do not mix under normal conditions. Instead, nutrients, gases, and waste products pass through the placental barrier via diffusion. If maternal and fetal blood mix, it could indicate a placental rupture or pathological condition.

A. Retained placental fragments
This is incorrect because retained placental fragments are more commonly associated with prolonged third-stage labor or incomplete placental expulsion, rather than fetal macrosomia.

B. Uterine atony
This is correct because a large baby (macrosomia) causes overdistension of the uterus, increasing the risk of uterine atony (failure of the uterus to contract effectively). This can lead to postpartum hemorrhage.

C. Puerperal infection
This is incorrect because puerperal infection is usually related to prolonged rupture of membranes, poor hygiene, or invasive procedures, rather than fetal size alone.

D. Thrombophlebitis
While pregnancy increases the risk of clot formation, the most immediate concern for this client is uterine atony and postpartum hemorrhage.

A. During the next attempt to get pregnant
This is incorrect because waiting until the next pregnancy increases the risk of congenital rubella syndrome in future pregnancies. The vaccine should be given immediately postpartum to provide immunity.

B. Immediately after delivery
This is correct because the rubella vaccine (MMR) is a live vaccine and is contraindicated during pregnancy due to teratogenic effects. It should be given postpartum before hospital discharge to prevent future rubella infections.

C. During the third trimester of pregnancy
This is incorrect because live vaccines are contraindicated in pregnancy due to the risk of fetal infection.

D. During the first trimester of pregnancy
This is incorrect because administering a live vaccine early in pregnancy is dangerous and could cause fetal harm or congenital anomalies.

A. Fetal movement felt by provider
This is correct because fetal movement confirmed by a healthcare provider is a positive sign of pregnancy, as it directly confirms fetal presence.

B. Positive pregnancy test
This is incorrect because a positive pregnancy test is a probable sign, not a positive sign. It detects hCG, which can also be produced in conditions like gestational trophoblastic disease (molar pregnancy).

C. Hegar’s sign
This is incorrect because Hegar’s sign (softening of the lower uterus) is a probable sign, not a positive sign, as it can occur due to other physiological changes.

D. Breast tenderness and nausea
This is incorrect because breast tenderness and nausea are presumptive signs of pregnancy, meaning they are subjective symptoms that could be caused by other conditions (e.g., PMS, stress, illness).

A. Unexplained weight gain
This is incorrect because weight gain is not a characteristic symptom of endometriosis. Endometriosis primarily affects the reproductive organs and is associated with pain and infertility rather than metabolic or weight-related changes.

B. Pain during menstrual period
This is correct because dysmenorrhea (painful menstruation) is a hallmark symptom of endometriosis due to the presence of ectopic endometrial tissue responding to hormonal changes.

C. Pain during intercourse
This is correct because dyspareunia (pain during intercourse) is a common symptom of endometriosis due to the inflammatory and fibrotic changes caused by ectopic endometrial tissue.

D. Infertility
This is correct because endometriosis can lead to infertility due to scarring, adhesions, and inflammation affecting the fallopian tubes and ovaries. Many clients with endometriosis seek medical attention due to difficulty conceiving.

A. "It halts cervical dilation."
This is incorrect because betamethasone does not stop cervical dilation or preterm labor. Medications like tocolytics (e.g., nifedipine, magnesium sulfate, terbutaline) are used to delay labor, while betamethasone is given to enhance fetal lung maturity.

B. "It increases the fetal heart rate."
This is incorrect because betamethasone does not directly increase fetal heart rate. While corticosteroids may cause temporary fetal tachycardia, their primary role is enhancing fetal lung development.

C. "It promotes fetal lung maturity."
This is correct because betamethasone is a corticosteroid given to promote the production of surfactant in the fetal lungs, reducing the risk of respiratory distress syndrome (RDS) in preterm infants. It is typically administered between 24 and 34 weeks of gestation in cases of anticipated preterm birth.

D. "It is used to stop preterm labor contractions."
This is incorrect because betamethasone does not stop contractions. Tocolytics like nifedipine, magnesium sulfate, and terbutaline are used for that purpose, whereas betamethasone is specifically for fetal lung development.

A. Observe an area of redness on the breast of a client who is 1 day postpartum.
Assessment is outside the scope of practice for an AP. The nurse must assess the redness, as it could indicate mastitis or engorgement requiring further evaluation.

B. Provide a sitz bath to a client who has a fourth-degree laceration and is 2 days postpartum.
Assisting with hygiene and comfort measures, such as a sitz bath, is within the AP’s scope of practice. The nurse should ensure that the client understands proper perineal care and has no contraindications.

C. Monitor vital signs during admission of a client who has gestational hypertension.
Clients with gestational hypertension require close monitoring, and initial admission assessments, including vital signs, must be performed by the nurse to identify signs of preeclampsia or worsening hypertension.

D. Change the initial perineal pad of a client who just transferred from labor and delivery.
The first perineal pad change is an assessment opportunity for the nurse, allowing them to evaluate bleeding amount, presence of clots, and signs of postpartum hemorrhage. The nurse should perform the initial assessment and pad change before delegating routine hygiene tasks to the AP.

Correct answers: The nurse's greatest concern is the client's risk of developing HELLP syndrome and related to thrombocytopenia and elevated liver enzymes.

Rationale:

I. HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets) is a severe form of preeclampsia that can lead to life-threatening complications.

Ii. Thrombocytopenia (low platelets) (120,000) increases the risk of bleeding.

Iii. Elevated liver enzymes (ALT 75, AST 78, Alkaline Phosphatase 184) suggest liver involvement, which is a hallmark of HELLP syndrome.

Preeclampsia:

• Blood pressure of 150/96 mmHg: A BP of ≥140/90 mmHg on two occasions at least 4 hours apart after 20 weeks of gestation in a previously normotensive client is diagnostic of preeclampsia.

Preeclampsia with Severe Features:

• Blood pressure of 162/112 mmHg: Severe hypertension is ≥160/110 mmHg on two occasions at least 4 hours apart. This is a criterion for severe preeclampsia, requiring immediate intervention to prevent complications like eclampsia or stroke.

• Elevated liver enzymes (ALT/AST > 2x the upper limit of normal) are indicative of severe preeclampsia due to hepatic involvement. This can progress to HELLP syndrome, increasing the risk of liver rupture and disseminated intravascular coagulation (DIC).

Neither:

• Negative for protein on a urine dipstick: Preeclampsia is typically diagnosed with proteinuria (≥300 mg in 24 hours or protein/creatinine ratio ≥0.3). A negative urine dipstick means proteinuria is absent, making preeclampsia unlikely. However, preeclampsia can also be diagnosed without proteinuria if other systemic features (e.g., thrombocytopenia, renal dysfunction) are present.

• Seizures in a client with preeclampsia indicate eclampsia, which is a medical emergency requiring magnesium sulfate to prevent further seizures. If the client had no preeclampsia, the seizures could be due to another cause (e.g., epilepsy, metabolic disturbance).