A client at 33 weeks' gestation comes to the emergency department with vaginal bleeding. Assessment reveals the following:

Onset of slight vaginal bleeding at 29 weeks with spontaneous cessation

Recent onset of bright red vaginal bleeding, more than with previous episode

No uterine contractions at present

Fetal heart rate within normal range

Uterus soft and nontender

Based on the assessment findings, which condition would the nurse likely suspect?

Polyhydramnios

Placenta previa

Placental abruption

Ruptured ectopic pregnancy

Answer and Explanation

The Correct Answer is B

A. Polyhydramnios refers to an excessive amount of amniotic fluid and typically presents with maternal discomfort, dyspnea, and possibly preterm labor, but not with vaginal bleeding as a primary symptom.

B. Placenta previa is the most likely diagnosis based on the assessment findings. It typically presents with painless, bright red vaginal bleeding in the second or third trimester, a soft, nontender uterus, no contractions, and a normal fetal heart rate. The bleeding may start spontaneously and often recurs. This fits the client's clinical picture precisely.

C. Placental abruption usually involves painful vaginal bleeding, a firm or tender uterus, and may be associated with uterine contractions or abnormal fetal heart rate patterns. The absence of pain and uterine tenderness in this case makes placental abruption less likely.

D. Ruptured ectopic pregnancy would not be expected at 33 weeks’ gestation. Ectopic pregnancies typically present in the first trimester and are accompanied by severe abdominal pain, vaginal bleeding, and signs of hypovolemic shock if ruptured.

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Correct Answer is D

Explanation

A. Clear liquid diet may be appropriate later in treatment once symptoms improve, but it is not typically initiated immediately in a client with severe hyperemesis gravidarum, especially if they are unable to keep any fluids down.

B. Administration of labetalol is used to treat hypertension, particularly in preeclampsia, and is not related to the treatment of hyperemesis gravidarum.

C. Small frequent meals are part of long-term management or mild cases, but for severe hyperemesis gravidarum requiring hospitalization, oral intake is usually withheld initially.

D. Nothing by mouth (NPO) is correct. In severe hyperemesis gravidarum, the client is often kept NPO to rest the gastrointestinal tract and prevent further vomiting. Intravenous (IV) fluids, electrolytes, and sometimes antiemetic medications are administered to manage dehydration and nutritional deficits before gradually resuming oral intake.

A. convection B. conduction C. radiation D. evaporation

Correct Answer is B

Explanation

A. Convection is the loss of heat due to air or fluid movement around the body. While keeping the newborn warm in a draft-free area can help with this, the blanket on the scale primarily addresses heat loss through contact with the cold surface.
B. Conduction occurs when heat is transferred from the baby’s body to a cooler surface that it comes into direct contact with, like the cold scale. By placing a warmed blanket on the scale, the nurse minimizes heat loss due to conduction, ensuring the baby stays warm.
C. Radiation involves heat transfer to cooler objects nearby, but a warmed blanket on the scale does not directly address heat loss through radiation.
D. Evaporation occurs when moisture on the skin evaporates, taking heat away. A warmed blanket would not primarily address evaporation; it’s meant to prevent conduction heat loss.

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Naxlex Comprehensive Predictor Exams

A client with severe hyperemesis gravidarum is admitted to the facility after being cared for at home without success. What would the nurse expect to include in the client's plan of care?

Correct Answer is D

Explanation

The nurse places a warmed blanket on the scale when weighing a newborn to minimize heat loss via which mechanism?

Correct Answer is B

Explanation

A nurse is assessing a newborn's reflexes. The nurse strokes the lateral sole of the newborn's foot from the heel to the ball of the foot to elicit which reflex?

A client is suspected of having a ruptured ectopic pregnancy. Which assessment would the nurse identify as the priority?

The nurse is reviewing the laboratory test results of a pregnant client. Which finding would alert the nurse to the development of HELLP syndrome?

A client who is breastfeeding her newborn tells the nurse, "I notice that when I feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now?" Which response by the nurse would be most appropriate?

A client who has just given birth to a healthy newborn required an episiotomy. Which action would the nurse implement immediately after birth to decrease the client's pain from the procedure?

A nurse is preparing a presentation about ways to minimize heat loss in the newborn. Which measure would the nurse include to prevent heat loss through convection?

While performing a physical assessment of a newborn boy, the nurse notes diffuse edema of the soft tissues of his scalp that crosses suture lines. The nurse documents this finding as:

A nurse is providing care to a postpartum woman. Which of the following behavior by the client would indicate the client is in the Taking in phase?