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. "It is possible that your baby experienced birth trauma that has caused some bleeding." While birth trauma can cause bleeding, it is not the most common cause of a small blood-tinged area in a newborn's diaper, particularly in female infants. Trauma-related bleeding would typically be more noticeable or involve more significant injury.

B. "Your baby has an infection that will need to be evaluated by the physician." This statement is unlikely, as the presence of a small amount of blood-tinged discharge in a newborn’s diaper is not typically a sign of infection. Infection would present with other symptoms, such as fever, irritability, or abnormal discharge.

C. "Breastfed babies often experience this type of bleeding problem due to lack of Vitamin K in the mother's milk." This is incorrect. Newborns are given a Vitamin K injection shortly after birth to prevent bleeding issues (such as Vitamin K deficiency bleeding). Lack of Vitamin K in the mother's milk is not a cause of blood-tinged discharge in female infants.

D. "Some female infants experience menstruation-like symptoms as a result of the mother's hormones." This is the correct response. A small amount of blood-tinged vaginal discharge (often described as pseudomenstruation) in female newborns is common and occurs due to the influence of the mother's hormones (mainly estrogen) passed to the baby in utero. It typically resolves within a few days to weeks and is considered a normal physiological response.

A. to enhance the clearing of the newborn's respiratory passages B. to aid in maturing the newborn's sucking reflex C. to encourage the development of maternal antibodies D. to facilitate maternal-infant bonding

Correct Answer is D

Explanation

A. To enhance the clearing of the newborn's respiratory passages is not the primary reason for putting the newborn to the breast immediately. While early skin-to-skin contact and breastfeeding are beneficial, the clearing of respiratory passages is more directly related to the initial care the baby receives (such as suctioning if necessary), not breastfeeding.

B. To aid in maturing the newborn's sucking reflex is not the main reason for immediate breastfeeding. The sucking reflex is typically well-established in most newborns by the time of birth, and breastfeeding can help reinforce it. However, the reflex is present and functional even if the baby is not immediately breastfeeding.

C. To encourage the development of maternal antibodies is important in the longer term. Breastfeeding does provide immunological benefits to the baby (like colostrum), but the immediate reason for putting the baby to the breast is more about bonding and initiating breastfeeding.

D. To facilitate maternal-infant bonding is the primary reason for encouraging early breastfeeding. Skin-to-skin contact and breastfeeding immediately after birth promote emotional bonding between the mother and baby, which is beneficial for both. It also promotes the release of oxytocin in the mother, which supports uterine involution and maternal well-being.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The new mother asks the nurse about the presence of a small blood-tinged area on her daughter's diaper. Which response by the nurse would be most accurate?

Correct Answer is D

Explanation

The nurse encourages the mother of a healthy newborn to put the newborn to the breast immediately after birth for which reason?

Correct Answer is D

Explanation

An ultrasound is performed on a client at term who is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on this finding, what would be the next action?

A woman with gestational hypertension develops eclampsia and experiences a seizure. Which intervention would the nurse identify as the priority?

Which action by the nurse is most effective to prevent sore nipples in a breastfeeding client?

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. The nurse determines that the drug is at a therapeutic level based on which result?

A nurse is teaching a pregnant woman with preterm prelabor rupture of membranes about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching?

Twenty minutes after birth, a baby begins to move his head from side to side, making eye contact with the mother, and pushes his tongue out several times. The nurse interprets this as:

A woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate?

The nurse dries the neonate thoroughly and promptly changes wet linens. The nurse does so to minimize heat loss via which mechanism?