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:

Induction of labor with intravenous oxytocin.

An emergency cesarean section

In-hospital fetal monitoring for 48 hours

Discharge home on strict bed rest

Answer and Explanation

The Correct Answer is B

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.

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Correct Answer is B

Explanation

A. Oral hypoglycemic medications. While some oral hypoglycemic agents, such as metformin or glyburide, are used in gestational diabetes, the first-line treatment is always dietary modification and exercise. Medications are only introduced if blood glucose levels remain uncontrolled with lifestyle changes.

B. Diet control and exercise. The initial treatment for gestational diabetes focuses on controlling blood glucose through dietary adjustments, portion control, and regular physical activity. If lifestyle modifications fail to maintain glucose levels within the target range, insulin or oral medications may be introduced.

C. Inhaled insulin. Inhaled insulin is not commonly used in pregnancy because its safety and efficacy for gestational diabetes have not been well established. Insulin therapy, if needed, is typically administered via subcutaneous injection rather than inhalation.

D. Regular insulin injections. Insulin therapy is considered if diet and exercise alone fail to control blood glucose levels. However, it is not the first-line treatment, as many women can successfully manage gestational diabetes without requiring insulin therapy.

A. Eclampsia B. Abruptio placentae C. Rupture of the uterus D. Placenta previa

Correct Answer is B

Explanation

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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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:

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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