A nurse is assessing a client who has placenta previa and is receiving fetal monitoring.
Which of the following clinical findings should the nurse expect?

Placement of an internal fetal spiral electrode is contraindicated because it requires ruptured membranes and no active vaginal bleeding. In cases of antepartum bleeding, especially without rupture of membranes, it increases infection risk and fetal injury.

Laboratory testing (CBC, blood type, Rh factor, coagulation studies) is anticipated to evaluate maternal blood loss, anemia, blood type compatibility, and coagulation status. These are essential for managing bleeding risk and potential transfusions.

IV fluids are anticipated to maintain maternal hemodynamic stability and manage possible blood loss, preventing hypovolemia and hypotension.

Abdominal ultrasound is anticipated for placental localization, fetal wellbeing assessment, and to differentiate causes of bleeding (placenta previa vs. abruption).

Betamethasone administration is anticipated at 30 weeks to accelerate fetal lung maturity in case of preterm delivery.

Continuous fetal heart rate (FHR) monitoring is essential to assess fetal status and detect hypoxia or distress promptly.

Digital cervical exam is contraindicated due to risk of exacerbating bleeding and infection in the presence of unknown placental position or bleeding source.

Choice A rationale

The human body possesses compensatory mechanisms, such as sympathetic nervous system activation leading to vasoconstriction and increased heart rate, that can maintain vital organ perfusion despite significant blood loss. These mechanisms can mask overt signs of shock, such as hypotension, until approximately 20-25% of the total blood volume (around 1000-1250 mL in an average adult) has been acutely lost. This delay in visible manifestations can be critical in situations like postpartum hemorrhage, where rapid blood loss can occur.

Choice B rationale

Hemorrhagic shock typically leads to a state of metabolic acidosis, not an increase in serum pH. This occurs due to inadequate tissue perfusion, resulting in anaerobic metabolism and the accumulation of lactic acid. The reduced oxygen delivery forces cells to switch from efficient aerobic respiration to less efficient anaerobic glycolysis, producing lactate as a byproduct, which lowers the blood pH. A normal serum pH range is 7.35 to 7.45.

Choice C rationale

While urine output is a valuable indicator of renal perfusion and overall circulatory status, it is not the most accurate or immediate indicator of *overall* organ perfusion. Other parameters like mental status, skin perfusion (capillary refill), and arterial blood pressure (MAP) provide more global and rapid assessments of tissue oxygenation. Urine output primarily reflects renal blood flow, which can be maintained by compensatory mechanisms even when other organs are hypoperfused. Normal urine output is generally considered to be 0.5 to 1 mL/kg/hr.

Choice D rationale

The standard resuscitation guideline for hemorrhagic shock is to administer 3 mL of isotonic crystalloid solution, such as lactated Ringer's, for every 1 mL of estimated blood loss. This 3: ratio accounts for the rapid redistribution of crystalloids from the intravascular space to the interstitial space, meaning that only about one-third remains within the vascular compartment to expand circulating blood volume effectively.