A nurse is caring for a female client, age 32, who is at 28 weeks of gestation, admitted to the antepartum unit with vaginal bleeding.

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client’s progress.

Answer and Explanation

The Correct Answer is []

Rationale for correct condition
Placenta previa occurs when the placenta partially or completely covers the cervical opening, causing painless bright red vaginal bleeding during the second or third trimester. The client’s presentation of painless vaginal bleeding without contractions or abdominal tenderness supports this diagnosis. Fundal height measuring 27 cm at 28 weeks aligns with normal gestation, and the absence of uterine irritability or pain differentiates it from abruptio placentae. Fetal heart rate of 170/min with minimal variability reflects fetal stress but no immediate decelerations. These features are consistent with placenta previa rather than other causes of bleeding.

Rationale for correct actions
Strict bed rest reduces mechanical disruption of the placenta previa site, minimizing further bleeding risk and improving maternal-fetal oxygenation. Large-bore IV access is essential to rapidly administer fluids or blood products if hemorrhage occurs, maintaining maternal hemodynamic stability. Both actions are critical for managing acute vaginal bleeding while ensuring safety until delivery or further intervention.

Rationale for correct parameters
Monitoring fetal well-being via continuous electronic fetal monitoring detects signs of hypoxia or distress, guiding timely interventions. Tracking vaginal bleeding quantifies blood loss and progression, essential to assess severity and need for transfusion. Both parameters directly evaluate maternal and fetal status during placenta previa management.

Rationale for incorrect conditions
Abruptio placentae involves premature placental separation causing painful bleeding and uterine tenderness, absent here. Chorioamnionitis presents with maternal fever, uterine tenderness, and fetal tachycardia due to infection, none reported. Vasa previa entails fetal vessel rupture causing rapid fetal distress and bleeding; no signs of fetal demise or sudden distress are evident.

Rationale for incorrect actions
Administering pitocin is contraindicated as it may cause contractions worsening bleeding in placenta previa. Methotrexate treats ectopic pregnancy or trophoblastic disease, unrelated here. Vaginal examination risks provoking hemorrhage and is avoided in placenta previa.

Rationale for incorrect parameters
White blood cell count monitors infection, not relevant in this case without fever or leukocytosis. Cervical dilation monitoring is contraindicated due to risk of hemorrhage in placenta previa. Beta-human chorionic gonadotropin levels evaluate pregnancy viability or trophoblastic disease, irrelevant here.

Take home points

Placenta previa presents as painless bright red bleeding in the third trimester.
Avoid vaginal examinations to prevent hemorrhage in placenta previa.
Strict bed rest and IV access are critical management steps.
Differentiate placenta previa from abruptio placentae by pain and uterine tenderness.

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Correct Answer is C

Explanation

Choice A rationale

Administering a rubella immunization during pregnancy is contraindicated because the rubella vaccine is a live attenuated virus vaccine. There is a theoretical risk of viral transmission to the fetus, which could lead to congenital rubella syndrome. Vaccination should occur postpartum to protect future pregnancies.

Choice B rationale

Breastfeeding is not contraindicated after receiving the rubella vaccine. Although rubella vaccine virus can be excreted in breast milk, it generally does not cause clinical illness in the infant and passive transfer of antibodies may provide some protection to the infant.

Choice C rationale

A rubella titer of 1: indicates a low level of rubella antibodies, meaning the client is susceptible to rubella infection. A titer of less than 1: or 1: is generally considered non-immune, requiring vaccination to prevent congenital rubella syndrome in future pregnancies.

Choice D rationale

Repeating a rubella titer in the third trimester is not a standard practice for assessing susceptibility. Once susceptibility is determined, the primary intervention is postpartum vaccination. The initial titer result accurately reflects immune status and further testing during pregnancy is unnecessary.

A. Observation of a sudden gush of amniotic fluid. B. Hypotension with a blood pressure of 85/40 mm Hg. C. Severe bradypnea with a respiratory rate of 10/min. D. Palpation of the fetal presenting part in the cervical os.

Correct Answer is B

Explanation

Choice A rationale

A sudden gush of amniotic fluid typically indicates rupture of membranes (ROM), which can be spontaneous or induced. While ROM can occur during labor, it is not a direct indicator of uterine rupture, which is a catastrophic event involving the tearing of the uterine wall and often presents with different clinical signs.

Choice B rationale

Hypotension with a blood pressure of 85/40 mm Hg is a critical finding suggesting hypovolemic shock, often due to internal hemorrhage, which is a common consequence of uterine rupture. The sudden loss of maternal blood into the abdominal cavity leads to a rapid decrease in circulating blood volume and subsequent systemic hypotension.

Choice C rationale

Severe bradypnea with a respiratory rate of 10/min is not a primary indicator of uterine rupture. Bradypnea often suggests central nervous system depression, possibly from medication effects or other neurological events, but is not a direct physiological response to the acute blood loss and pain associated with a uterine tear.

Choice D rationale

Palpation of the fetal presenting part in the cervical os is a normal finding during labor progression as the fetus descends. However, if the presenting part is palpated higher or outside the uterus, it can indicate expulsion of the fetus into the abdominal cavity following a complete uterine rupture, which is an abnormal and emergent finding.

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Correct Answer is C

Explanation

Correct Answer is B

Explanation

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