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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: This statement is insensitive and dismissive, as it implies that the client's feelings are not valid or important. The nurse should not minimize the client's disappointment or guilt, but rather acknowledge and respect them.
Choice B reason: This statement is inaccurate and irrelevant, as it does not address the client's emotional needs or concerns. The nurse should not give false or misleading information, or focus on the physical aspects of recovery, but rather provide emotional support and education.
Choice C reason: This statement is presumptuous and unrealistic, as it assumes that the client wants or can have another pregnancy, and that a vaginal delivery is possible or preferable. The nurse should not make assumptions or promises, or compare different modes of delivery, but rather explore the client's feelings and expectations.
Choice D reason: This statement is empathetic and respectful, as it reflects the client's feelings and validates them. The nurse should use active listening and therapeutic communication skills, such as open-ended questions, clarifications, and summarizations, to help the client cope and express her emotions.
Correct Answer is B
Explanation
Choice A reason: Uterine enlargement greater than expected for gestational age is not a typical manifestation of ectopic pregnancy, because the embryo is implanted outside the uterus, usually in the fallopian tube. The uterus may be slightly enlarged due to hormonal changes, but not more than expected for the gestational age.
Choice B reason: Unilateral, cramp-like abdominal pain is a common manifestation of ectopic pregnancy, because the embryo grows and stretches the fallopian tube, causing inflammation and irritation. The pain may be mild or severe, depending on the size and location of the ectopic pregnancy, and may radiate to the shoulder or back.
Choice C reason: Severe nausea and vomiting is not a specific manifestation of ectopic pregnancy, because it can be caused by other conditions, such as hyperemesis gravidarum, gastroenteritis, or appendicitis. The client may have mild nausea and vomiting due to hormonal changes, but not more than usual for the gestational age.
Choice D reason: Large amount of vaginal bleeding is not a usual manifestation of ectopic pregnancy, because the bleeding is usually internal, into the abdominal cavity. The client may have spotting or light bleeding due to the detachment of the endometrium, but not heavy or profuse bleeding.
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