A nurse is reviewing charts for clients who have a diagnosis of placental abruption. Which of the following clients needs an emergent cesarean section?
Client who is at 32 weeks of gestation, has a blood pressure of 138/86 mm Hg, and a heart rate of 71/min with a category I fetal heart tracing.
Client who is at 39 weeks of gestation, has a blood pressure of 122/88 mm Hg, and a pulse of 88/min with a fetal demise.
Client who is at 38 weeks of gestation, has a fetal demise and is hemorrhaging, and has a cervix dilated at 4 cm.
Client who is at 37 weeks of gestation, has a blood pressure of 116/68 mm Hg, a pulse of 72/min, and has a category I fetal heart tracing with cervical dilation at 3 cm.
The Correct Answer is C
Choice A rationale
This client's vital signs are within normal ranges for 32 weeks of gestation. A category I fetal heart tracing indicates normality, suggesting no immediate need for an emergent cesarean section.
Choice B rationale
A fetal demise at 39 weeks of gestation does not necessitate an emergent cesarean section, as the fetus is no longer viable, and other delivery methods can be considered based on the mother's condition.
Choice C rationale
Hemorrhaging at 38 weeks with a fetal demise and cervix dilated at 4 cm indicates a medical emergency. Rapid intervention, including a cesarean section, is necessary to control bleeding and protect the mother’s life.
Choice D rationale
Normal vital signs and a category I fetal heart tracing with cervical dilation at 3 cm at 37 weeks indicate no immediate need for an emergent cesarean section, as labor can proceed naturally under observation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Amniotic fluid embolism is characterized by the sudden onset of respiratory distress due to the entry of amniotic fluid into the maternal circulation.
Choice B rationale
Maternal bradycardia is not a specific symptom of amniotic fluid embolism and may be related to other cardiovascular conditions.
Choice C rationale
Category 1 fetal heart tracing indicates normal fetal heart rate and is not associated with amniotic fluid embolism.
Choice D rationale
Acute, continuous abdominal pain could indicate other obstetric emergencies but is not specifically linked to amniotic fluid embolism symptoms like respiratory distress.
Correct Answer is A
Explanation
Choice A rationale
History of uterine rupture poses a significant risk for a trial of labor after cesarean (TOLAC) due to the potential recurrence of uterine rupture, which can be life-threatening for both mother and fetus.
Choice B rationale
Previous cesarean section for breech presentation is not a contraindication for TOLAC. Patients with prior cesarean deliveries can consider TOLAC if there are no additional risk factors.
Choice C rationale
Previous low transverse cesarean section birth is often considered suitable for TOLAC, as the lower segment incision has a lower risk of rupture compared to vertical or classical incisions.
Choice D rationale
Low-risk pregnancy alone is not a contraindication for TOLAC. It is essential to assess other factors such as uterine scarring, maternal health, and fetal status when considering TOLAC eligibility.
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