A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which of the following findings support this diagnosis?

Painless red vaginal bleeding

Intermittent abdominal pain following passage of bloody mucus

Increasing abdominal pain with a nonrelaxed uterus

Abdominal pain with scant red vaginal bleeding

Answer and Explanation

The Correct Answer is A

Choice A reason: Painless red vaginal bleeding is the most characteristic finding of placenta previa, which is a condition where the placenta covers the cervical opening and can cause bleeding in the third trimester. Painless red vaginal bleeding occurs because the placenta is detached from the lower uterine segment as the cervix dilates or effaces, and the blood vessels are torn. The bleeding can be mild or severe, and it can recur or persist until delivery.

Choice B reason: Intermittent abdominal pain following passage of bloody mucus is not a finding that supports placenta previa, but rather a finding that suggests normal labor or preterm labor. Intermittent abdominal pain is caused by uterine contractions, which can be regular or irregular, and can increase in frequency, duration, and intensity. Bloody mucus is the mucus plug that is expelled from the cervix as it dilates or effaces, and it can be tinged with blood or streaked with blood.

Choice C reason: Increasing abdominal pain with a nonrelaxed uterus is not a finding that supports placenta previa, but rather a finding that indicates abruptio placentae, which is a premature separation of the placenta from the uterine wall. Increasing abdominal pain is caused by the bleeding and the hematoma formation behind the placenta, which can compress the uterine muscle and the nerve endings. Nonrelaxed uterus is a sign of uterine hypertonicity, which can reduce the blood flow and the oxygen delivery to the fetus.

Choice D reason: Abdominal pain with scant red vaginal bleeding is not a finding that supports placenta previa, but rather a finding that suggests ectopic pregnancy, which is a condition where the fertilized ovum implants outside the uterine cavity, usually in the fallopian tube. Abdominal pain is caused by the rupture of the tube and the bleeding into the peritoneal cavity, which can irritate the diaphragm and the abdominal wall. Scant red vaginal bleeding is a sign of implantation bleeding, which can occur when the fertilized ovum attaches to the tube wall.

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Correct Answer is C

Explanation

Choice A reason: Initiation of pushing is not an appropriate nursing action, as it can increase the bleeding and the risk of placental separation, which can cause fetal hypoxia, hemorrhage, or shock. Pushing is contraindicated in clients with placenta previa, which is a condition where the placenta covers the cervical opening and can cause painless, bright red bleeding in the third trimester.

Choice B reason: Examination to determine cervical status is not an appropriate nursing action, as it can cause trauma and perforation of the placenta, which can lead to severe bleeding and infection. Examination is contraindicated in clients with placenta previa, unless it is confirmed by ultrasound that the placenta is not low-lying or covering the cervix.

Choice C reason: Preparation for cesarean birth is an appropriate nursing action, as it is the preferred mode of delivery for clients with placenta previa, especially if the bleeding is heavy, the fetus is mature, or the fetal distress is present. Cesarean birth can prevent the complications of placenta previa, such as fetal hypoxia, hemorrhage, or shock.

Choice D reason: A magnesium sulfate infusion is not an appropriate nursing action, as it is a drug that prevents seizures and lowers the blood pressure in clients with severe preeclampsia, which is a hypertensive disorder of pregnancy. Magnesium sulfate is not indicated for clients with placenta previa, unless they also have severe preeclampsia or eclampsia.

A. "It determines the presence of maternal antibodies in the newborn's blood." B. "It determines if kernicterus will occur in the newborn." C. "It detects Rh-positive antibodies in the mother's blood." D. "It detects Rh-negative antibodies in the newborn's blood."

Correct Answer is C

Explanation

Choice A reason: This statement is incorrect, as it describes the direct Coombs test, not the indirect Coombs test. The direct Coombs test is performed on the newborn's blood, and it detects the presence of maternal antibodies that have attached to the newborn's red blood cells. The direct Coombs test can help diagnose hemolytic disease of the newborn, which is a condition where the maternal antibodies destroy the newborn's red blood cells, causing anemia and jaundice.

Choice B reason: This statement is incorrect, as it is not the purpose of the indirect Coombs test, but rather a possible complication of hemolytic disease of the newborn. Kernicterus is a severe form of jaundice that occurs when the bilirubin level in the blood is very high, and it can cause brain damage, deafness, or death. Kernicterus can be prevented by treating the jaundice with phototherapy or exchange transfusion.

Choice C reason: This statement is correct, as it describes the indirect Coombs test, which is performed on the mother's blood, and it detects the presence of Rh-positive antibodies that have formed in response to the exposure to the Rh-positive blood of the newborn. The indirect Coombs test can help identify the risk of hemolytic disease of the newborn, and guide the administration of Rh immunoglobulin, which is a medication that prevents the formation of Rh-positive antibodies.

Choice D reason: This statement is incorrect, as it is not possible for the newborn to have Rh-negative antibodies, since the newborn has Rh-positive blood. Rh-negative antibodies are produced by Rh-negative individuals who have been exposed to Rh-positive blood, such as Rh-negative mothers who have Rh-positive newborns. Rh-negative antibodies can cross the placenta and attack the Rh-positive red blood cells of the newborn, causing hemolytic disease of the newborn.

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A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which of the following findings support this diagnosis?

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A nurse is caring for a client who is in labor at 40 weeks of gestation and reports that she has saturated two perineal pads with blood in the past 30 min. The nurse caring for her suspects placenta previa. Which of the following is an appropriate nursing action?

Correct Answer is C

Explanation

A nurse is caring for a client who is 6 hr postpartum. The client is Rh-negative and her newborn is Rh-positive. The client asks why an indirect Coombs test was ordered by the provider. Which of the following is an appropriate response by the nurse?

Correct Answer is C

Explanation

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