A client comes to the emergency room reporting severe abdominal cramping and heavy bleeding at 10 weeks gestation. Cervical examination reveals heavy bleeding, the cervical os is open and tissue is present. Which type of abortion is the client experiencing?

Choice A reason: Preeclampsia is not the correct answer, as it is a hypertensive disorder of pregnancy that causes high blood pressure, proteinuria, and edema. Preeclampsia can be a risk factor for abruptio placentae, which is a premature separation of the placenta from the uterine wall, but it is not a complication of it. Preeclampsia does not cause petechiae or bleeding around the IV access site, but rather headaches, blurred vision, or epigastric pain.

Choice B reason: Anaphylactoid syndrome of pregnancy is not the correct answer, as it is a rare and fatal condition that occurs when the amniotic fluid enters the maternal circulation and causes an allergic reaction. Anaphylactoid syndrome of pregnancy can occur as a complication of abruptio placentae, but it is not indicated by the petechiae or bleeding around the IV access site. Anaphylactoid syndrome of pregnancy would cause respiratory distress, hypotension, or cardiac arrest.

Choice C reason: Puerperal infection is not the correct answer, as it is a bacterial infection of the reproductive tract that occurs after childbirth. Puerperal infection can occur as a complication of abruptio placentae, but it is not indicated by the petechiae or bleeding around the IV access site. Puerperal infection would cause fever, foul-smelling lochia, or pelvic pain.

Choice D reason: Disseminated intravascular coagulation is the correct answer, as it is a coagulation disorder that causes widespread clotting and bleeding in the body. Disseminated intravascular coagulation can occur as a complication of abruptio placentae, and it is indicated by the petechiae and bleeding around the IV access site. Disseminated intravascular coagulation would also cause a low platelet count, a prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), and a low fibrinogen level.

Choice A reason: Obtaining a type and crossmatch is not the first action that the nurse should take, as it is a preparatory step for blood transfusion, which may or may not be needed. The nurse should first identify the cause and severity of the hypotension, and initiate immediate interventions to stop the bleeding and restore the circulation.

Choice B reason: Administering oxytocin infusion is not the first action that the nurse should take, as it is a pharmacological intervention that requires a prescription and an assessment of the uterine tone and bleeding. The nurse should first evaluate the firmness of the uterus and massage it if needed, to stimulate the contraction and retraction of the uterine muscle.

Choice C reason: Initiating oxygen therapy by nonrebreather mask is not the first action that the nurse should take, as it is a supportive intervention that aims to improve the oxygen delivery to the tissues and organs. The nurse should first address the underlying cause of the hypotension, which is most likely postpartum hemorrhage, and prevent further blood loss and shock.

Choice D reason: Evaluating the firmness of the uterus is the first action that the nurse should take, as it can help determine the source and extent of the bleeding, and guide the subsequent interventions. The nurse should palpate the fundus and check the lochia, and report any signs of uterine atony, which is the most common cause of postpartum hemorrhage.