A client arrives to OB triage at 37 weeks gestation with a known complete placenta previa this pregnancy.
She reports feeling some inconsistent contractions over the last 4 hours and wants to know if she is in labor.
The client asks the nurse why the provider did not perform a vaginal exam.
What is the most appropriate answer by the nurse?

A vaginal exam will increase the risk of rupturing your membranes.

A vaginal exam could cause vaginal bleeding.

A vaginal exam would cause infection if you are not in labor.

A vaginal exam could initiate preterm labor.

Answer and Explanation

The Correct Answer is B

Choice A rationale

While rupturing membranes can be a concern, the primary issue with a vaginal exam in the presence of placenta previa is the risk of severe bleeding. This choice is partially correct but not the most accurate answer.

Choice B rationale

With placenta previa, the placenta covers the cervix, and a vaginal exam could easily disrupt it, leading to significant vaginal bleeding. This bleeding can be dangerous for both the mother and the baby, making this the most accurate reason to avoid a vaginal exam.

Choice C rationale

Infection risk is a concern with any invasive procedure, but it is not the primary reason to avoid a vaginal exam in the case of placenta previa. The main concern is the risk of bleeding.

Choice D rationale

Initiating preterm labor is a possible risk with any vaginal exam late in pregnancy, but it is not the primary concern in cases of placenta previa. The main issue is the potential for causing severe bleeding.

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Correct Answer is B

Explanation

Choice A rationale

Placenta previa leads to painless vaginal bleeding when the placenta covers the cervix. It does not typically require continuous fetal monitoring or prepare for cesarean birth based on the findings alone.

Choice B rationale

Abruptio placentae is the premature detachment of the placenta, causing abdominal pain, and can lead to fetal distress. Continuous fetal monitoring and preparation for cesarean birth are consistent with this complication.

Choice C rationale

Gestational hypertension is high blood pressure that develops after 20 weeks of pregnancy but without the presence of protein in the urine or other symptoms of preeclampsia. It would not typically necessitate the measures described.

Choice D rationale

Preeclampsia involves high blood pressure and proteinuria after 20 weeks of gestation and can cause severe complications for both the mother and fetus. However, it does not directly lead to the specific intervention of continuous fetal monitoring and cesarean preparation. .

A. "My twins are at higher risk of twin to twin transfusion because they share a placenta.”. B. "Twin to twin transfusion results in over perfusion to both babies causing circulatory overload and CHF.”. C. "Twin to twin transfusion is very common in all multiple gestation pregnancies.”. D. "My twins are at a lower risk for twin to twin transfusion because they share the placenta.”. .

Correct Answer is A

Explanation

Choice A rationale

Monochorionic-monoamniotic twins share a single placenta and amniotic sac, increasing the risk for twin to twin transfusion syndrome (TTTS). This condition occurs due to unbalanced blood flow through the shared placenta, leading to discrepancies in blood volume between the twins.

Choice B rationale

TTTS does not result in overperfusion to both babies. Instead, it causes one twin (the donor) to become underperfused, leading to anemia and growth restriction, while the other twin (the recipient) becomes overperfused, causing polycythemia and circulatory overload, which can lead to heart failure.

Choice C rationale

TTTS is not very common in all multiple gestation pregnancies; it primarily affects monochorionic twins. In dichorionic twins, each twin has its own placenta, making TTTS highly unlikely.

Choice D rationale

Monochorionic twins sharing a placenta actually increases their risk for TTTS, not lowers it. The shared placenta creates a scenario where blood vessels can cross and lead to uneven blood flow between the twins. .

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is at 32 weeks of gestation.Continuous fetal monitoring and vital signs per protocol are required.Prepare for cesarean birth.A nurse reviews the assessment findings and determines the findings are consistent with which of the following complications?

Correct Answer is B

Explanation

A nurse in a prenatal clinic is discussing the risks of twin to twin transfusion syndrome with an 18 week pregnant client with monochorionic-monoamniotic (mono-mono) twins.Which of the following statements by the client shows an understanding of the education?

Correct Answer is A

Explanation

A nurse is admitting a client at 33 weeks gestation who experienced PPROM 4 hours ago.The client is asking when her next vaginal exam will be since her first exam revealed she is 2 cm dilated.Which of the following reasons does the nurse explain for not performing another vaginal exam?

You are attending a staff meeting when the discussion about preeclampsia complications arises.Which of the following statements by the nurse educator is correct regarding HELLP syndrome?

A 38-year-old multigravida returns to the clinic for a routine prenatal visit at 36 weeks gestation.Assessment findings include blood pressure: 149/93 mm Hg, pulse: 80 beats/min, respiratory rate: 16 breaths/min.The nurse suspects preeclampsia.What additional finding would the nurse assess for?

A nurse is caring for a client who has been diagnosed with hyperemesis gravidarum.Which of the following conditions are risk factors for hyperemesis gravidarum?

A nurse is caring for a client in the OB clinic at 34 weeks gestation.Which of the following symptoms reported by the client is indicative of cholestasis of pregnancy?

A nurse is providing care at a routine visit for a 28-year-old female client who is at 36 weeks of gestation in the clinic. Exhibits Which of the following findings should the nurse report to the provider? (Select all that apply.)

A laboring client with preeclampsia is prescribed magnesium sulfate 2g/h IVPB. The pharmacy sent the IV to the unit labeled magnesium sulfate 20g/500mL normal saline. To administer the correct dose, the nurse should set the pump to deliver how many milliliters per hour?