A nurse is reviewing the electronic medical record (EMR) of a client who is in the labor and delivery triage unit. Nurses' Notes 1700: Client is 38-weeks of gestation and reports recent onset of uterine contractions, dark red vaginal bleeding, and abdominal pain that started approximately 1 hour prior to arrival. Client reports taking prescribed prenatal vitamins and methyldopa that is prescribed orally twice per day. 1730: Physical Exam: Past Medical History: Gestational hypertension General: anxious Cardiovascular: S1, S2, no murmur Respiratory: bilateral lung sounds clear Abdomen: hard and rigid, uterine hypertonicity, tenderness upon palpation to left upper quadrant. Toco and ultrasound transducer applied. FHR 140/min. Genitourinary: Mild amount of dark red blood noted on the perineal pad For each of the client's findings from the EMR, click to specify if the finding is consistent with placenta previa or abruptio placenta. Each finding may support more than 1 condition. There must be at least 1 selection in every column. There does not need to be a selection in every row.

Uterine tone

Vaginal bleeding characteristics

Pain rate

Client weeks of gestation

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A,B"}}

•   Uterine tone
o   Placenta previa: Not typically associated with abnormal uterine tone.
o   Abruptio placenta: Associated with hard and rigid abdomen, uterine hypertonicity, and tenderness.
•   Vaginal bleeding characteristics
o   Placenta previa: Typically characterized by bright red, painless vaginal bleeding.
o   Abruptio placenta: Often associated with dark red, painful vaginal bleeding.
•   Pain rate
o   Placenta previa: Usually presents with minimal or no pain.
o   Abruptio placenta: Associated with sudden, severe abdominal pain and tenderness.
•   Client weeks of gestation
o   Placenta previa: Commonly diagnosed later in pregnancy, around 30 weeks or later.
o   Abruptio placenta: Can occur at any point after 20 weeks of gestation, but often seen closer to term.

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Correct Answer is A

Explanation

A. BUN 30 mg/dL: Correct. Elevated BUN (blood urea nitrogen) levels are associated with impaired kidney function, which is common in preeclampsia.

B. Hgb 9.9 g/dL: Incorrect. While anemia can occur in preeclampsia, it is not the primary laboratory finding associated with the condition. The hemoglobin level provided is low but not specific to preeclampsia.

C. Serum uric acid 2.5 mg/dL: Incorrect. Elevated serum uric acid levels are often associated with preeclampsia, but the value provided is below the normal range and would not be expected in this condition.

D. Casual blood glucose 228 mg/dL: Incorrect. Although gestational diabetes can occur, it is not a direct result of preeclampsia. The glucose level given is high but not specific to the condition.

A. Bradycardia B. Flushed face C. Hypotension D. Polyuria

Correct Answer is C

Explanation

A. Incorrect. Bradycardia is not typically associated with decreased cardiac output but can indicate other conditions.

B. Incorrect. A flushed face is not a specific indicator of decreased cardiac output.

C. Correct. Hypotension is a sign of decreased cardiac output, which can occur due to excessive vaginal bleeding.

D. Incorrect. Polyuria is not directly related to decreased cardiac output; it may be related to other conditions.

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Naxlex Comprehensive Predictor Exams

A nurse is reviewing a laboratory report for a client who is at 33 weeks of gestation and has preeclampsia. Which of the following laboratory results should the nurse expect?

Correct Answer is A

Explanation

A nurse is assessing a client who gave birth 12 hr ago and is experiencing excessive vaginal bleeding. Which of the following findings indicates the client is experiencing decreased cardiac output?

Correct Answer is C

Explanation

A nurse is caring for a client who is in active labor. The nurse notes early decelerations of the FHR on the fetal monitor tracing. The nurse should identify that which of the following conditions causes early decelerations in the FHR?

A nurse is assessing a client who is at 31 weeks of gestation and is receiving magnesium sulfate via continuous IV infusion for preterm labor. Which of the following findings should the nurse report to the provider?

A nurse is assessing a newborn whose mother had gestational diabetes mellitus. Which of the following findings should the nurse identify as a manifestation of hypoglycemia?

A nurse is assessing a client who gave birth 1 week ago. The client states, "I don't know what's wrong. I love my baby, but I feel so let down and I seem to cry for no reason." The nurse should identify that the client is experiencing which of the following emotional responses to birth?

A nurse is reviewing the laboratory results of a newborn who is 32 hours old and has a cephalohematoma. Which of the following findings should the nurse expect as a result of this condition?

A nurse is caring for a client who is in labor and has an epidural for pain control. Which of the following clinical manifestations is an adverse effect of epidural anesthesia?

A nurse is admitting a client who is at 33 weeks of gestation and has preeclampsia with severe features. Which of the following actions should the nurse take?