A nurse is caring for a client who has an abruptio placentae. Which of the following findings should the nurse expect?
First trimester bleeding
Severe abdominal pain
Nausea
Delayed menses
The Correct Answer is B
A. First trimester bleeding. Abruptio placentae typically occurs in the third trimester, not the first. First trimester bleeding is more commonly associated with miscarriage or ectopic pregnancy.
B. Severe abdominal pain. Abruptio placentae involves the premature separation of the placenta from the uterine wall, often leading to sudden, severe abdominal pain and possibly vaginal bleeding. It is a medical emergency requiring immediate attention.
C. Nausea. While nausea can occur during pregnancy, it is not a hallmark symptom of abruptio placentae and does not assist in differentiating it from other complications.
D. Delayed menses. Delayed menses may indicate early pregnancy, but it is not related to abruptio placentae, which occurs later in pregnancy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Remove the safety inspection sticker before plugging in the IV pump. The safety inspection sticker is proof that the equipment has passed a required check. It should not be removed, as doing so may violate facility policies and regulatory standards.
B. Grasp the IV pump cord when unplugging it from the electrical outlet. Pulling on the cord rather than the plug itself can damage the cord or outlet and pose an electrical hazard. Always unplug by gripping the plug directly.
C. Check the cords of the IV pump for fraying. Inspecting cords for fraying or damage is essential before using any electrical equipment. Damaged cords can lead to electric shock, equipment failure, or fire, and must be reported and replaced.
D. Ensure that the electric outlet has two prongs for the IV pump. Medical equipment should be plugged into a three-pronged (grounded) outlet to prevent electrical shock. Two-prong outlets are not grounded and are inappropriate for hospital-grade devices.
Correct Answer is C
Explanation
A. Apply the largest cuff available. Using a cuff that is too large can result in falsely low readings. Cuff size should match the client’s arm circumference to ensure accuracy, but simply switching to the largest cuff does not resolve difficulty in auscultation.
B. Deflate the cuff quickly. Rapid deflation can cause the nurse to miss the systolic and diastolic sounds, making it harder to obtain an accurate reading. The cuff should be deflated at a steady rate of 2–3 mmHg per second.
C. Use the palpatory method to determine blood pressure. When sounds are difficult to auscultate, the palpatory method is a reliable alternative. This involves palpating the radial pulse while inflating the cuff to estimate systolic pressure, which helps guide a more accurate auscultatory attempt.
D. Place the arm above the level of the client's heart. Elevating the arm above heart level can lower the pressure artificially, resulting in an inaccurate measurement. For correct results, the arm should be supported at heart level.
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