A client is attempting to deliver vaginally despite the fact that her previous delivery was by cesarean birth.
Her contractions are 2-3 minutes apart, lasting from 75 to 100 seconds.
Suddenly, the client complains of intense abdominal pain, and the fetal monitor stops picking up contractions.
The nurse recognizes that which of the following has occurred?
Placenta previa.
Uterine rupture.
Prolapsed cord.
Abruptio placentae.
The Correct Answer is B
Choice A rationale
Placenta previa is a condition where the placenta implants in the lower part of the uterus, potentially covering the cervix. It typically presents with painless vaginal bleeding, especially in the later trimesters, and is not directly associated with sudden, intense abdominal pain and cessation of contractions during labor.
Choice B rationale
Uterine rupture is a serious complication of vaginal birth after cesarean (VBAC), especially with strong, frequent contractions. The sudden onset of intense abdominal pain and the cessation of contractions, along with fetal distress indicated by the absent fetal heart rate tracing, are classic signs of uterine rupture. The prior cesarean scar weakens the uterine wall, making it susceptible to tearing under the stress of labor.
Choice C rationale
A prolapsed umbilical cord occurs when the cord descends into the vagina ahead of the presenting part, potentially compressing the fetal blood vessels and causing fetal distress. While fetal heart rate abnormalities would be present, it is not typically associated with sudden, intense maternal abdominal pain and cessation of contractions.
Choice D rationale
Abruptio placentae is the premature separation of the placenta from the uterine wall. It can cause sudden abdominal pain, vaginal bleeding (though not always), and fetal distress. However, the cessation of uterine contractions is not a typical finding in abruptio placentae. Contractions may continue, although they might be accompanied by increased uterine tone.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
The ventrogluteal muscle, located in the hip, is a safe site for intramuscular injections in adults and children older than seven months due to its distance from major nerves and blood vessels. However, the vastus lateralis muscle in the thigh is the preferred site for IM injections in newborns and infants due to its well-developed muscle mass and accessibility.
Choice B rationale
The deltoid muscle, located in the upper arm, is small and not well-developed in newborns, making it an unsuitable site for intramuscular injections. There is also a risk of injury to the brachial nerve and blood vessels in this area in neonates.
Choice C rationale
The dorsogluteal muscle, located in the buttocks, is no longer the recommended site for intramuscular injections in infants and young children due to the proximity of the sciatic nerve and major blood vessels, increasing the risk of nerve damage.
Choice D rationale
The vastus lateralis muscle, located on the anterolateral aspect of the thigh, is the recommended site for intramuscular injections in newborns. It is a large, well-developed muscle that is easily accessible and away from major nerves and blood vessels, making it a safe and effective site for administering vitamin K to prevent hemorrhagic disease of the newborn.
Correct Answer is B
Explanation
Choice A rationale
Thoroughly cooking meat to an internal temperature of 160°F (71°C) kills the Toxoplasma gondii parasite, thus preventing transmission through ingestion of contaminated meat. This is a crucial preventive measure recommended for pregnant women.
Choice B rationale
Drinking unpasteurized milk poses a risk of toxoplasmosis, as well as other foodborne illnesses like listeriosis and brucellosis. Pasteurization is a process that heats milk to a specific temperature for a set time, killing harmful bacteria and parasites, including Toxoplasma gondii. Therefore, this statement indicates a need for further instruction, as pregnant women should consume only pasteurized dairy products.
Choice C rationale
Cat feces can contain oocysts of Toxoplasma gondii, which can become infectious after a period of sporulation. Avoiding contact with materials possibly contaminated with cat feces, such as litter boxes and garden soil, is an important measure to prevent toxoplasmosis.
Choice D rationale
Handling raw meat can expose a person to Toxoplasma gondii cysts. Avoiding touching mucous membranes of the mouth or eyes after handling raw meat and washing hands thoroughly reduces the risk of self-inoculation with the parasite.
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