A nurse is caring for a client who is pregnant and has suspected placenta previa. Which of the following should the nurse monitor the client for?
Large amount of bright red vaginal bleeding
Severe pain with no bleeding
High-grade fever
Sudden sharp pain in the lower abdomen
The Correct Answer is A
Choice A rationale:
Large amount of bright red vaginal bleeding is the cardinal sign of placenta previa. This is because the placenta is abnormally positioned low in the uterus, covering the cervix partially or completely. When the cervix starts to dilate in preparation for labor, it can detach from the uterine wall, leading to significant bleeding. The blood is typically bright red, indicating fresh bleeding, and can be painless.
Severity of bleeding: The amount of bleeding can vary from spotting to massive hemorrhage, and it may start suddenly or gradually. Even a small amount of bleeding can be a sign of placenta previa and should not be ignored.
Risks of hemorrhage: Prompt recognition and management of bleeding are crucial to prevent potentially life-threatening hemorrhage for both the mother and the fetus.
Choice B rationale:
Severe pain with no bleeding is not a typical presentation of placenta previa. While some women with placenta previa may experience mild abdominal pain or cramping, severe pain without bleeding is more suggestive of placental abruption, a condition where the placenta prematurely separates from the uterine wall.
Choice C rationale:
High-grade fever is not a direct symptom of placenta previa. However, if a woman with placenta previa develops a fever, it could indicate an infection, which can further complicate the condition and require immediate medical attention.
Choice D rationale:
Sudden sharp pain in the lower abdomen can be a sign of placental abruption but is not characteristic of placenta previa.
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Correct Answer is B
Explanation
Choice A:
The umbilicus is typically the location of the fundus at around 20 weeks of gestation, not 22 weeks.
If the fundus is at the umbilicus at 22 weeks, it could indicate that the fetus is not growing at the expected rate. This would warrant further investigation, such as an ultrasound, to assess fetal growth and development.
Choice C:
3 cm below the umbilicus is too low for a 22-week gestation.
This would suggest that the fetus is smaller than expected for the gestational age.
Possible causes of this include incorrect dating of the pregnancy, fetal growth restriction, or oligohydramnios (low amniotic fluid).
Choice D:
5 cm above the umbilicus is too high for a 22-week gestation.
This could indicate that the woman is carrying multiples, has polyhydramnios (excess amniotic fluid), or that the fetus is larger than expected for the gestational age (macrosomia).
Importance of Fundal Height Measurement:
Fundal height measurement is a simple, non-invasive way to assess fetal growth and development during pregnancy. It is typically measured at each prenatal appointment, starting at around 20 weeks of gestation.
By tracking the fundal height over time, healthcare providers can identify potential problems with fetal growth and make necessary interventions.
Correct Answer is B
Explanation
Choice A:
Applying ice to the perineal area is not a recommended intervention for suspected placenta previa. While ice can help reduce swelling and pain in some cases, it does not address the underlying concern of potential placental bleeding.
Focusing on external monitoring for fetal well-being and avoiding any actions that could disrupt the placenta are the priorities in this situation.
Choice C:
Completing a vaginal exam is contraindicated in suspected placenta previa. Inserting fingers into the vagina can disrupt the placenta and potentially cause heavy bleeding, increasing the risk of preterm labor, fetal distress, or maternal hemorrhage. Non-invasive assessment methods are crucial to protect the placenta and prevent complications.
Choice D:
Performing a rectal exam is also not indicated for suspected placenta previa. It does not provide information about the placental position and could potentially stimulate contractions, which are undesirable in this situation.
External fetal monitoring is a safer and more informative approach.
Choice B:
Applying an external fetal monitor is the most appropriate action for a nurse caring for a client with suspected placenta previa. It allows for continuous assessment of fetal heart rate and activity, which can help detect any signs of fetal distress or placental abruption.
It is a non-invasive method that does not carry the risks associated with vaginal or rectal exams.
Early identification of any fetal compromise can lead to prompt interventions to ensure the best possible outcomes for both mother and baby.
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