A nurse in an obstetrics clinic is assisting with the care of a group of clients.
Which of the following clients should the nurse see first?
A client who is at 8 weeks of gestation and reports uterine cramping.
A client who is at 10 weeks of gestation and reports a new onset of urinary frequency and urgency.
A client who is at 38 weeks of gestation and reports a mucoid vaginal discharge with intermittent low back pain.
A client who is at 33 weeks of gestation and reports epigastric pain and visual changes.
The Correct Answer is D
Choice A rationale
Uterine cramping during the first trimester can indicate a potential spontaneous abortion, but it is often a benign finding related to the stretching of uterine ligaments. While it requires assessment to rule out complications, it does not represent an immediate systemic threat to the mother. The nurse should prioritize clients with symptoms suggestive of severe preeclampsia or other life-threatening conditions over those with localized, non-specific cramping.
Choice B rationale
Urinary frequency and urgency are common physiological changes in the first trimester due to the increasing size of the uterus pressing against the bladder and hormonal shifts. While these symptoms can also indicate a urinary tract infection, which requires treatment to prevent preterm labor, they are not typically an emergency. This client is stable and does not take priority over a client exhibiting signs of severe gestational hypertensive disorders.
Choice C rationale
A mucoid vaginal discharge, often referred to as the mucus plug or operculum, combined with intermittent low back pain at 38 weeks of gestation, is a normal sign of impending labor. These findings indicate that the cervix is beginning to soften and efface as the body prepares for childbirth. Since this is an expected physiological process at term, this client is considered stable and does not require immediate emergency intervention.
Choice D rationale
Epigastric pain and visual changes at 33 weeks of gestation are classic manifestations of severe preeclampsia. Epigastric pain suggests hepatic involvement, such as subcapsular hematoma or liver distention, while visual changes indicate cerebral edema or arteriolar vasospasms. These symptoms signal a high risk for eclampsia and organ failure. This client is the highest priority due to the potential for rapid maternal and fetal deterioration or seizure activity.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Malnutrition can certainly affect the overall health of the mother and the developing fetus, but it is rarely the primary cause of a spontaneous abortion in developed clinical settings. Severe deficiencies in specific nutrients like folic acid can lead to neural tube defects, but the body generally prioritizes fetal growth until maternal reserves are dangerously low. It does not account for the high percentage of early pregnancy losses seen in the first trimester compared to other factors.
Choice B rationale
Fetal chromosomal abnormalities are the most common cause of spontaneous abortion, accounting for approximately 50 percent to 60 percent of all early pregnancy losses. These errors usually occur during gametogenesis or early cell division and include trisomies, polyploidy, or monosomy X. The biological system often identifies these non-viable genetic configurations, leading to a natural termination of the pregnancy. This is a random occurrence in most cases rather than a result of maternal health behaviors or environmental factors.
Choice C rationale
Smoking is a known modifiable risk factor that increases the risk of miscarriage, placental abruption, and low birth weight due to nicotine-induced vasoconstriction and carbon monoxide exposure. While it significantly impairs oxygen delivery to the fetus and damages placental vessels, it is statistically less common as a primary cause compared to genetic errors. Many women who smoke are still able to carry a pregnancy to term, whereas major chromosomal imbalances almost universally result in spontaneous loss.
Choice D rationale
Antiphospholipid antibody syndrome is an autoimmune condition characterized by the presence of antibodies that increase the risk of blood clots and pregnancy complications. It is a significant cause of recurrent pregnancy loss and late-term stillbirth due to placental infarction and thrombosis. However, in the general population of women experiencing a single spontaneous abortion, it is a much rarer underlying etiology than the spontaneous chromosomal mishaps that occur during the complex process of human conception.
Correct Answer is A
Explanation
Choice A rationale
Ultrasound is the definitive diagnostic tool for identifying placenta previa because it non-invasively visualizes the position of the placenta relative to the internal cervical os. It can determine if the placenta is low-lying, marginal, partial, or complete. Safety is paramount when painless vaginal bleeding occurs in the third trimester. Using high-frequency sound waves allows the provider to confirm the diagnosis without making physical contact with the cervix, thereby preventing the risk of severe hemorrhage.
Choice B rationale
Performing a digital vaginal examination is strictly contraindicated in any pregnant client experiencing third-trimester vaginal bleeding until placenta previa has been ruled out by ultrasound. Inserting a finger into the cervix can accidentally puncture or tear a low-lying or previa placenta, leading to sudden, catastrophic maternal hemorrhage and fetal distress. This mechanical disruption of the placental site can cause rapid exsanguination, making this action extremely dangerous and a violation of standard obstetric safety protocols.
Choice C rationale
Obtaining a complete blood count is an important supportive action to assess the degree of maternal blood loss and systemic stability, but it cannot diagnose the underlying cause of the bleeding. A CBC measures hemoglobin (normal 12 to 16 g/dL) and hematocrit (normal 37 percent to 47 percent), providing data on anemia or infection. While necessary for management, it does not provide anatomical information regarding placental placement, which is required to differentiate previa from other causes like abruption.
Choice D rationale
A speculum examination is generally avoided until the placental location is confirmed via ultrasound. Although less invasive than a digital exam, the speculum could still potentially irritate the lower uterine segment or placenta if it is positioned over the cervix. The primary goal in the presence of painless bleeding is to avoid any cervical manipulation that might trigger a massive bleed. Ultrasound remains the preferred first-line diagnostic step to ensure maternal and fetal safety before any pelvic instrumentation occurs.
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