A nurse is assessing a client who has placenta previa and is receiving fetal monitoring.
Which of the following clinical findings should the nurse expect?

Variable decelerations.

Painless vaginal bleeding.

Rigid abdomen.

Uterine tachysystole.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Variable decelerations are typically caused by umbilical cord compression, which can occur in various obstetric scenarios but are not a specific expected finding for placenta previa. In placenta previa, the primary issue is placental implantation over or near the cervical os, leading to distinct clinical manifestations.

Choice B rationale

Painless vaginal bleeding is the hallmark clinical finding of placenta previa. This occurs because the placenta is implanted in the lower uterine segment, potentially covering the internal cervical os. As the cervix effaces or dilates, the placenta separates from the uterine wall, leading to bleeding without the associated pain of uterine contractions.

Choice C rationale

A rigid abdomen is a classic sign of abruptio placentae, where the placenta prematurely detaches from the uterine wall. This causes internal bleeding and uterine spasm, leading to a board-like, tender abdomen, which is distinct from the typical presentation of placenta previa.

Choice D rationale

Uterine tachysystole, characterized by excessive uterine contractions, is a common finding in conditions like abruptio placentae or during labor induction. It is not typically associated with placenta previa, where the primary concern is the placental position and the risk of hemorrhage rather than abnormal contraction patterns.

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Correct Answer is ["B","C"]

Explanation

Choice A rationale

Meconium stools are a normal physiological finding in a newborn during the first 24-48 hours of life. This thick, tarry, dark-green stool is composed of intestinal epithelial cells, amniotic fluid, bile, and water, reflecting fetal gastrointestinal tract development and function. Its presence indicates typical bowel activity.

Choice B rationale

Depressed fontanels indicate dehydration in a newborn. The fontanels are soft spots on a baby's head where the skull bones have not yet fused. When a baby is dehydrated, the fluid volume in the brain decreases, causing the fontanel to appear sunken below the normal contour of the skull, which necessitates immediate medical attention due to potential complications.

Choice C rationale

Rust-stained urine, also known as "brick dust" urine, in a newborn can indicate dehydration. This discoloration is caused by the excretion of urate crystals, which are a normal metabolic byproduct. However, in concentrated urine, these crystals become more visible, suggesting insufficient fluid intake and requiring further assessment to prevent significant dehydration.

Choice D rationale

Overlapping suture lines, also known as molding, are a common and expected finding in newborns, especially after vaginal delivery. This temporary reshaping of the fetal skull allows it to pass more easily through the birth canal and typically resolves spontaneously within a few days as the brain grows and fills the cranial cavity.

A. Fetal heart rate. B. Deep tendon reflexes. C. Blood glucose. D. Blood pressure. E. Pain level.

Correct Answer is ["A","E"]

Explanation

Choice A rationale

Fetal heart rate assessment is paramount before administering an opioid analgesic during labor. Opioids can cross the placental barrier and cause central nervous system depression in the fetus, potentially leading to decreased fetal heart rate variability or transient decelerations. Therefore, a baseline and ongoing fetal heart rate monitoring is essential to ensure fetal well-being.

Choice B rationale

Deep tendon reflexes are primarily assessed when administering magnesium sulfate for preeclampsia, not typically before opioid analgesics. Magnesium sulfate can cause central nervous system depression and affect neuromuscular transmission, necessitating regular monitoring of deep tendon reflexes to assess for signs of toxicity. Opioids do not directly affect reflex activity in the same manner.

Choice C rationale

Blood glucose levels are not a standard assessment before administering opioid analgesics during labor. Blood glucose monitoring is crucial for clients with diabetes or gestational diabetes, or those receiving intravenous dextrose, but it is not directly related to opioid administration and its immediate effects on the mother or fetus.

Choice D rationale

Blood pressure assessment is crucial before administering an opioid analgesic because these medications can cause maternal hypotension due to their vasodilatory effects. Hypotension can reduce placental perfusion, compromising fetal oxygenation. Establishing a baseline blood pressure and monitoring it closely after administration helps ensure maternal cardiovascular stability and fetal well-being.

Choice E rationale

Pain level assessment is fundamental before administering an opioid analgesic. The primary purpose of administering an opioid is to alleviate labor pain. A thorough assessment of the intensity, location, and character of pain guides the choice, dosage, and timing of the analgesic, ensuring effective pain management and patient comfort while minimizing unnecessary medication.

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A nurse is assessing a client who has placenta previa and is receiving fetal monitoring. Which of the following clinical findings should the nurse expect?

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A nurse is assessing a client who has placenta previa and is receiving fetal monitoring.
Which of the following clinical findings should the nurse expect?