A woman at 39 weeks gestation with a history of preeclampsia is admitted to the labor and delivery. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, dark red bleeding and a tense, very painful abdomen. The nurse suspects the onset of:

Eclampsia

Abruptio placentae

Rupture of the uterus

Placenta previa

Answer and Explanation

The Correct Answer is B

A. Eclampsia. Eclampsia is characterized by seizures in a patient with preeclampsia, but it does not cause dark red vaginal bleeding, a tense abdomen, or increased contraction frequency. While eclampsia is a serious complication, the symptoms described are more indicative of placental abruption.

B. Abruptio placentae. Abruptio placentae (placental abruption) occurs when the placenta prematurely separates from the uterine wall, causing painful, dark red vaginal bleeding, frequent contractions, and a tense, rigid uterus (uterine hypertonicity). This is a medical emergency because it can lead to severe fetal distress, maternal hemorrhage, and disseminated intravascular coagulation (DIC).

C. Rupture of the uterus. Uterine rupture presents with sudden, severe abdominal pain, loss of fetal station, and fetal distress, often with maternal hemodynamic instability. While it is an emergency, it is more commonly associated with a history of prior uterine surgery (such as a cesarean section), which is not mentioned in this case.

D. Placenta previa. Placenta previa presents with painless, bright red vaginal bleeding, not dark red bleeding with severe pain and uterine hypertonicity. Placenta previa is caused by an abnormally implanted placenta over the cervix, but it does not typically cause a firm, tense uterus or excessive contractions.

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Correct Answer is B

Explanation

A. Induction of labor with intravenous oxytocin. Induction is contraindicated in cases of abruptio placentae with a Category III fetal heart rate tracing, as labor induction can worsen fetal distress and maternal bleeding. An immediate cesarean section is the safest intervention to prevent fetal and maternal complications.

B. An emergency cesarean section. A Category III fetal heart rate tracing with minimal variability and a prolonged deceleration indicates severe fetal distress, requiring immediate delivery. Partial abruptio placentae can cause fetal hypoxia, maternal hemorrhage, and potential fetal demise. The priority is an emergency cesarean section to ensure the best outcome for both mother and baby.

C. In-hospital fetal monitoring for 48 hours. Continuous monitoring is essential in cases of mild abruptio placentae without fetal distress, but in this case, a Category III tracing indicates an immediate threat to the fetus, making waiting inappropriate.

D. Discharge home on strict bed rest. Abruptio placentae is a serious obstetric emergency, and home management is never appropriate when fetal distress is present. Immediate intervention is necessary to prevent fetal and maternal complications.

A. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B. Effects on the fetus and newborn can include decreased alertness and delayed sucking C. Intravenous (IV) patient-controlled analgesia (PCA) results in increased use of an analgesic D. Intramuscular (M) administration is preferred over IV administration

Correct Answer is B

Explanation

A. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. While systemic analgesics do cross the placenta, they actually affect the fetus more readily than the mother because the fetal liver and kidneys are immature, making drug metabolism and excretion slower. This leads to prolonged effects on the newborn.

B. Effects on the fetus and newborn can include decreased alertness and delayed sucking. Opioid analgesics, such as fentanyl, meperidine, or morphine, can cause neonatal respiratory depression, reduced alertness, and difficulty initiating breastfeeding due to delayed sucking reflex. If administered too close to delivery, the newborn may require respiratory support or naloxone to reverse opioid effects.

C. Intravenous (IV) patient-controlled analgesia (PCA) results in increased use of an analgesic. PCA allows controlled dosing of pain medication, often leading to less total medication use because the patient receives smaller, more frequent doses rather than large, single doses. This helps maintain stable pain control without excessive sedation.

D. Intramuscular (IM) administration is preferred over IV administration. IV administration is preferred over IM because it provides faster pain relief and better dose control. IM injections have delayed absorption and an unpredictable effect, making IV the preferred route for labor analgesia.

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A woman at 39 weeks gestation with a history of preeclampsia is admitted to the labor and delivery. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, dark red bleeding and a tense, very painful abdomen. The nurse suspects the onset of:

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Naxlex Comprehensive Predictor Exams

A client at 35 weeks' gestation is admitted with a partial abruptio placenta and a Category III fetal heart rate tracing with minimal variability and a prolonged deceleration. The nurse anticipates a plan of care for this client that includes most importantly:

Correct Answer is B

Explanation

With regard to systemic analgesics administered during labor, nurses should be aware that:

Correct Answer is B

Explanation

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