A primigravida at 39 weeks' gestation has dark red vaginal bleeding and complains of pain continuing between contractions. The nurse palpates the abdomen, which is firm and shows no sign of relaxation.
Which complication does the nurse suspect?
Preterm labor.
Placenta previa.
Abruptio placentae.
Placenta accreta.
The Correct Answer is C
Choice C rationale
Abruptio placentae is the premature separation of the placenta from the uterine wall. The classic signs include dark red vaginal bleeding (due to the pooling of blood behind the placenta), constant and intense abdominal pain, and a rigid, hypertonic uterus that does not relax between contractions. This rigidity is caused by the hemorrhage, clots, and resulting irritation and sustained contraction of the myometrium.
Choice A rationale
Preterm labor is characterized by regular uterine contractions causing cervical changes before 37 weeks' gestation. While contractions cause pain, the uterus typically relaxes completely between them, and the bleeding, if present, is usually bright red and less profuse than that seen with abruptio placentae, and it does not cause sustained uterine firmness.
Choice B rationale
Placenta previa is the implantation of the placenta over or near the cervical os. Its hallmark sign is painless, bright red vaginal bleeding that often occurs late in the second or third trimester. The uterus remains soft and relaxed, unlike the hard, board-like abdomen found with a severe placental abruption.
Choice D rationale
Placenta accreta involves abnormal adherence of the placenta to the uterine wall, typically becoming symptomatic at delivery when the placenta fails to separate. While it can cause bleeding, it does not typically present with the acute, severe abdominal pain and the sustained, board-like uterine rigidity seen before delivery, as it is a pathology of adherence, not separation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C"]
Explanation
Choice A rationale
An analgesic like meperidine (Demerol) or butorphanol (Stadol) is typically used for pain management during labor but is not a primary therapeutic agent for addressing preterm labor (PTL) itself. While pain relief may be important, the essential interventions for PTL at 31 weeks gestation focus on stopping contractions and preparing the fetus for potential early delivery.
Choice B rationale
Corticosteroids, such as betamethasone or dexamethasone, are administered to the client in PTL between 24 and 34 weeks gestation. These medications promote fetal lung maturity by stimulating the production and release of surfactant and reduce the incidence and severity of respiratory distress syndrome (RDS), intraventricular hemorrhage, and neonatal mortality.
Choice C rationale
A tocolytic is a class of drugs used to suppress uterine contractions in an attempt to delay delivery, giving time for corticosteroids to take effect and for in-utero transfer if necessary. Examples include magnesium sulfate, nifedipine, or terbutaline, aiming to prolong the pregnancy by at least 48 hours to maximize steroid benefit.
Choice D rationale
An oxytocic medication, such as oxytocin (Pitocin) or methylergonovine, stimulates uterine contractions and is used for labor induction/augmentation or to prevent/treat postpartum hemorrhage. Providing an oxytocic to a client in preterm labor is contraindicated as it would accelerate delivery, which is the exact outcome one is attempting to prevent.
Correct Answer is ["B","C","D","F","G"]
Explanation
Choice A rationale
Placing a rolled towel under the client's knees offers minimal elevation to the hips and would be insufficient to relieve pressure on the prolapsed umbilical cord. Elevation of the hips is critical to displace the fetus and alleviate cord compression, thereby restoring umbilical blood flow and preventing fetal hypoxia and brain damage. More effective positioning, like Trendelenburg or modified Sims, is required to optimize this decompression and support fetal safety.
Choice B rationale
Immediate notification of the obstetric health care provider is a priority due to the acute, life-threatening nature of an umbilical cord prolapse, which requires rapid definitive intervention. This allows the provider to prepare for an immediate delivery, typically by Cesarean section, which is the fastest way to resolve the compression and prevent fetal mortality from prolonged hypoxia and acidosis.
Choice C rationale
Administering oxygen via a non-rebreather mask (typically 10-15 L/min) to the client increases the maternal partial pressure of oxygen (PO_2), which in turn elevates the oxygen available for placental transfer to the fetus. This maximizes fetal oxygenation and helps mitigate the effects of hypoxia resulting from the compromised umbilical circulation.
Choice D rationale
Positioning the client in a Trendelenburg (supine with the head lower than the feet) or modified Sims (lateral recumbent with the hips elevated) utilizes gravity to displace the fetal presenting part away from the pelvis and the compressed cord. This crucial maneuver aims to relieve pressure on the prolapsed umbilical cord and restore umbilical blood flow, thereby preventing fetal distress.
Choice E rationale
Continuous internal fetal monitoring (IFM) requires the placement of a fetal scalp electrode and an intrauterine pressure catheter (IUPC). While continuous monitoring is essential, IFM is contraindicated in the setting of a prolapsed cord because the instrumentation could potentially worsen the cord compression or introduce infection. External monitoring should be used.
Choice F rationale
Using a sterile gloved hand to exert gentle, sustained upward pressure on the presenting part aims to manually elevate the fetus, thereby relieving compression on the prolapsed umbilical cord. This is a critical and immediate life-saving intervention to restore blood flow to the fetus while preparations are made for emergency delivery to avoid fetal anoxia.
Choice G rationale
Umbilical cord prolapse is an obstetric emergency requiring immediate delivery to prevent severe fetal hypoxia, acidosis, and potentially death. Immediate preparation for a Cesarean birth is the standard, safest, and most rapid definitive intervention to deliver the fetus before prolonged compression causes irreversible harm.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.