The nurse is collecting data from the client 24 hr later.
How should the nurse interpret the findings?

Condition: Placenta previa

2 actions:

• Reinforce bed rest and maintain IV access
• Prepare for an emergency cesarean birth

2 parameters:

• Fetal heart rate
• Maternal oxygen saturation

Rationale for correct condition: Placenta previa is indicated by painless, bright red vaginal bleeding in the third trimester, without abdominal pain or uterine tenderness. The fetal heart rate shows abnormalities with minimal variability, which can occur due to placental issues. Fundal height consistent with gestational age and absence of contractions support this diagnosis. Diagnosing this early is crucial as it poses significant risks to both the mother and fetus. The client’s history of bleeding and current symptoms align with placenta previa more than other conditions.

Rationale for actions: Reinforcing bed rest helps minimize bleeding and maintains stability. IV access is crucial for fluid management and potential blood transfusion. Preparing for an emergency cesarean birth ensures prompt delivery if maternal or fetal status deteriorates, preventing severe complications. Administering broad-spectrum antibiotics isn’t directly indicated as there's no sign of infection. Methotrexate is inappropriate here as it treats ectopic pregnancies, not placental issues. Encouraging ambulation might exacerbate bleeding, worsening the condition.

Rationale for parameters: Monitoring fetal heart rate assesses fetal well-being and detects distress early. Maternal oxygen saturation is vital to ensure adequate oxygen delivery to both mother and fetus. WBC count isn't immediately relevant unless there's an infection concern. Urine output doesn’t directly indicate placental health. Uterine contractions are irrelevant since there are no signs of preterm labor or irritability.

Rationale for incorrect conditions: Abruptio placentae usually involves painful bleeding with uterine tenderness or contractions. Preterm labor is characterized by regular contractions leading to cervical changes, absent here. Uterine rupture often involves severe pain, sudden fetal distress, and maternal shock, none of which are present.

Choice A rationale

Medroxyprogesterone acetate injections are typically administered every three months, not once per month. It is a long-acting contraceptive method that works by preventing ovulation and thickening cervical mucus to prevent sperm penetration.

Choice B rationale

Combined estrogen-progestin contraceptive pills can actually shorten and lighten menstrual periods for many users. These pills regulate the menstrual cycle and decrease menstrual flow, making periods more manageable.

Choice C rationale

Diaphragms typically need to be replaced every 1-2 years, depending on the type and condition of the device. Regular check-ups with a healthcare provider ensure the diaphragm fits properly and remains effective in preventing pregnancy.

Choice D rationale

Oral contraceptives have been shown to reduce the risk of endometrial cancer by preventing the thickening of the uterine lining, which lowers the chance of abnormal cell growth. The protective effect increases with prolonged use.