A nurse in the labor and delivery triage unit reviews the electronic medical record (EMR) of a client reporting severe abdominal pain.
Which of the following findings is most consistent with abruptio placenta?
Low uterine tone with mild vaginal bleeding.
Rigid uterine tone with dark vaginal bleeding.
Soft uterine tone with painless vaginal bleeding.
Low uterine tone with absence of vaginal bleeding.
The Correct Answer is B
Choice A rationale: Low uterine tone with mild vaginal bleeding is more indicative of placenta previa rather than abruptio placenta. Placenta previa involves the placenta covering the cervix, leading to painless bleeding. Uterine tone remains soft as there is no detachment of the placenta from the uterine wall. Abruptio placenta, however, is characterized by uterine rigidity due to blood accumulation between the placenta and uterine wall.
Choice B rationale: Rigid uterine tone with dark vaginal bleeding is a hallmark of abruptio placenta. The rigidity arises from blood pooling behind the placenta, causing uterine muscle contraction. Dark vaginal bleeding occurs as the blood is often concealed and clotted before expulsion. This condition is a medical emergency due to the risk of maternal hemorrhage and fetal hypoxia. Prompt diagnosis and intervention are critical to prevent severe complications.
Choice C rationale: Soft uterine tone with painless vaginal bleeding is characteristic of placenta previa, not abruptio placenta. Placenta previa involves the placenta partially or completely covering the cervix, leading to painless bleeding as the placenta detaches from the lower uterine segment. The uterine tone remains soft because there is no significant blood accumulation or uterine muscle contraction, unlike in abruptio placenta.
Choice D rationale: Low uterine tone with absence of vaginal bleeding does not align with abruptio placenta. While concealed abruptio placenta can occur without visible bleeding, the uterine tone is typically rigid due to blood accumulation. Low uterine tone suggests a lack of uterine contraction or detachment, which is inconsistent with the pathophysiology of abruptio placenta. This finding may indicate other obstetric conditions rather than abruptio placenta.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Ampicillin is a first-line antibiotic effective against group B streptococcus B-hemolytic bacteria, preventing neonatal infection during labor. It targets the bacterial cell wall synthesis and is safe in pregnancy.
Choice B rationale
Azithromycin is a macrolide antibiotic, mainly used for atypical pathogens like Mycoplasma or Chlamydia. It is not the standard treatment for group B streptococcus infections during labor.
Choice C rationale
Ceftriaxone is a broad-spectrum cephalosporin. Though effective for various bacterial infections, it is not the preferred treatment for intrapartum group B streptococcus prevention.
Choice D rationale
Acyclovir is an antiviral medication targeting herpes simplex virus replication. It has no efficacy against bacterial infections like group B streptococcus.
Correct Answer is C
Explanation
Choice A rationale
Bradycardia, or a heart rate below 60 beats per minute, is inconsistent with decreased cardiac output in this context. Tachycardia is a more typical compensatory response to significant blood loss postpartum.
Choice B rationale
A flushed face is not a physiological indicator of decreased cardiac output. Decreased cardiac output commonly leads to pallor and cool, clammy skin due to reduced peripheral perfusion.
Choice C rationale
Hypotension, defined as blood pressure below 90/60 mmHg, occurs due to reduced blood volume and cardiac output in excessive postpartum bleeding, impairing adequate perfusion to organs and tissues.
Choice D rationale
Polyuria, or excessive urination, does not directly indicate decreased cardiac output. Instead, oliguria or decreased urine output, often below 30 mL/hour, is a common sign of poor perfusion.
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