A nurse is assessing a client at 32 weeks gestation.
Which client statement would lead the nurse to suspect preterm labor rather than Braxton Hicks contractions?

Choice A rationale

Using only one finger for chest compressions on an infant is insufficient to generate the force necessary to compress the chest wall. Effective CPR requires the heart to be squeezed between the sternum and the spine to maintain cardiac output and systemic perfusion. One finger does not provide enough surface area or pressure to achieve the required depth of approximately 1.5 inches or one-third the anterior-posterior diameter of the chest, leading to inadequate blood flow.

Choice B rationale

For a single rescuer performing CPR on a 6-month-old infant, the two-finger technique is the evidence-based standard. The nurse places two fingers on the breastbone, just below the nipple line, to perform compressions. This technique allows for the precise application of pressure on the small surface area of an infant's chest. It ensures that the rescuer can reach the appropriate depth of 4 cm while allowing for full chest recoil, which is critical for coronary artery filling.

Choice C rationale

The heel of one hand is the technique typically reserved for children who have reached the age of one or more, depending on their physical size. For a 6-month-old infant, the heel of a hand is too large and covers too much of the thoracic cavity. This could result in trauma to the ribs or internal organs, such as the liver or spleen, because the pressure is not localized over the sternum, where it is most effective.

Choice D rationale

The heel of two hands is the technique utilized for adult CPR and is never appropriate for an infant. The force generated by two hands would cause catastrophic skeletal and internal injury to a 6-month-old. Infants have very compliant chest walls, and the excessive pressure from an adult-style compression would likely result in multiple rib fractures and lung contusions, making successful resuscitation impossible due to the severe mechanical damage inflicted during the process. .

Choice A rationale

Marginal placenta previa occurs when the edge of the placenta is located within 2 centimeters of the internal cervical os but does not cover it. In this scenario, as the cervix dilates, the risk of bleeding increases, but a vaginal delivery might still be considered depending on the proximity and maternal-fetal status. This description does not match the patient in the question, whose placenta entirely covers the opening, representing a more significant obstruction and higher clinical risk.

Choice B rationale

Partial placenta previa is a condition where the placenta covers a portion of the internal cervical os but not the entire opening. While this also presents a high risk for significant hemorrhage during labor as the cervix effaces and dilates, it is distinct from a total or complete obstruction. The clinical management is similar to complete previa in that a cesarean section is almost always required, but the anatomical definition differs based on the extent of the cervical coverage.

Choice C rationale

Complete placenta previa, also known as total previa, occurs when the placenta entirely covers the internal cervical os. This prevents the possibility of a safe vaginal delivery because the placenta would be delivered before the fetus, leading to catastrophic maternal hemorrhage and fetal hypoxia. The classic presentation is sudden, painless, bright red bleeding in the third trimester as the lower uterine segment thins. This finding necessitates a planned cesarean delivery to ensure the safety of both mother and neonate.

Choice D rationale

Absent placenta previa is not a standard clinical term used to describe placental positioning. The term simply implies the absence of the condition, meaning the placenta is normally implanted in the upper segment of the uterus, away from the cervical opening. In a normal pregnancy, the placenta should be fundal or lateral. Identifying the absence of previa is important for confirming that a patient is a candidate for a trial of labor, but it does not describe the pathology presented. .