A 26-year old having her first baby is 28 weeks pregnant. She experiences bright red, painless vaginal bleeding, soaking one pad. Upon her arrival at the hospital, after placing her on the FHR Monitor, what would be an expected diagnostic procedure?
Internal fetal monitoring
Amniocentesis for fetal lung maturity
Contraction stress test
Ultrasound for placenta location
The Correct Answer is D
A. Internal fetal monitoring. Internal fetal monitoring is contraindicated when placenta previa is suspected because it involves inserting a catheter or electrode into the uterus, which can increase the risk of hemorrhage if the placenta is covering the cervix.
B. Amniocentesis for fetal lung maturity. While fetal lung maturity assessment may be relevant if early delivery is being considered, it is not an immediate diagnostic procedure for evaluating the cause of vaginal bleeding. The priority is to determine placenta location and rule out placenta previa.
C. Contraction stress test. A contraction stress test evaluates fetal response to contractions but is not the appropriate initial diagnostic test in a patient with vaginal bleeding. Stimulating contractions could worsen bleeding if placenta previa or another placental abnormality is present.
D. Ultrasound for placenta location. The first-line diagnostic test for painless, bright red vaginal bleeding in the third trimester is an ultrasound. It helps determine whether the bleeding is due to placenta previa, a condition where the placenta partially or completely covers the cervix, which requires careful management to prevent complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. No action is necessary since a decrease in the woman's blood pressure is expected. While a drop in blood pressure is a common side effect of a spinal block, a 20% decrease is significant and can compromise placental perfusion, leading to fetal distress. Intervention is necessary to restore circulation.
B. Decrease her intravenous (IV) rate to a keep vein-open rate. This is incorrect because IV fluids help counteract hypotension. Instead of decreasing the IV rate, the nurse may need to increase fluid administration to improve blood pressure and maintain perfusion.
C. Encourage her to empty her bladder. A full bladder can affect labor progression but does not directly cause or correct hypotension. The priority in this scenario is restoring blood pressure to ensure adequate fetal oxygenation.
D. Turn the woman to the left lateral position or place a pillow under her hip. This is the most appropriate intervention. A left lateral position or elevating her right hip helps relieve aortocaval compression, improving blood flow to the uterus and stabilizing blood pressure. Additional interventions, such as IV fluid boluses or vasopressors (e.g., ephedrine), may be needed if hypotension persists.
Correct Answer is A
Explanation
A. Contraction frequency of 1 minute. Misoprostol (Cytotec) is used for cervical ripening, but excessive uterine contractions (tachysystole), defined as more than five contractions in 10 minutes, can lead to fetal distress and uterine rupture. If contractions are occurring every minute, this indicates hyperstimulation, requiring immediate discontinuation of the medication and possible intervention with tocolytics to relax the uterus.
B. Cervix is 50% effaced. Cervical effacement is a normal part of labor progression and does not indicate a need to stop Cytotec treatment. Misoprostol is intended to help soften and ripen the cervix, and 50% effacement suggests the cervix is responding appropriately.
C. Maternal respiratory rate of 24. A respiratory rate of 24 breaths per minute is within the upper normal range for pregnancy due to increased metabolic demands. It does not indicate an adverse reaction to misoprostol or warrant discontinuation of treatment.
D. Fetal heart baseline of 150. A fetal heart rate of 150 beats per minute is within the normal range of 110-160 bpm and does not indicate fetal distress. There is no reason to stop Cytotec based on this finding.
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