What is the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy?
Assessing fetal heart rate (FHR) and maternal vital signs
Performing a venipuncture for hemoglobin and hematocrit levels
Monitoring uterine contractions
Placing clean disposable pads to collect any drainage
The Correct Answer is A
Assessing fetal heart rate (FHR) and maternal vital signs would be the highest priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy. This is because fetal distress or maternal instability may require immediate medical intervention, such as delivery via emergency cesarean section or blood transfusions, respectively.
Therefore, assessing the FHR and maternal vital signs will help to determine the urgency of the situation and guide the next steps in the management of the patient. Once the patient's condition has stabilized, performing venipuncture for hemoglobin and hematocrit levels, monitoring uterine contractions, and placing clean disposable pads to collect any drainage can be done as appropriate.
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Related Questions
Correct Answer is D
Explanation
The biophysical profile (BPP) would yield more detailed information about the fetus in this scenario. The BPP is a prenatal ultrasound evaluation that assesses fetal well-being by evaluating five biophysical variables: fetal breathing movements, fetal movements, fetal tone, amniotic fluid volume, and fetal heart rate. The BPP is a more detailed assessment of fetal well-being compared to a nonstress test and can provide valuable information about the fetus's overall health and well-being, including any potential issues or difficulties.
MSAFP screening is a blood test that can detect certain fetal abnormalities, but it does not provide detailed information about fetal well-being.
Percutaneous umbilical blood sampling (PLBS) is an invasive test that is used to obtain a sample of fetal blood for testing in cases of suspected fetal anemia or other blood disorders. Ultrasound for fetal anomalies is a diagnostic tool used to detect structural abnormalities or defects in the fetus. While it can provide some information about fetal well-being, it is not as comprehensive as the BPP in evaluating fetal health and wellness.
Correct Answer is B
Explanation
The patient should not be ambulating before the procedure as this may cause fetal descent and prevent the success of the version. The other interventions listed are appropriate and important for the safety and well-being of the patient and the fetus during the procedure.
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