A nurse is caring for a client who has an abruptio placentae. Which of the following findings should the nurse expect?

Rationale:

A. Insert an indwelling urinary catheter: While important for monitoring urine output and renal perfusion, catheter insertion is not the immediate priority in a trauma situation. It should be done after vascular access is secured and life-threatening conditions are addressed.

B. Administer packed RBCs: Blood transfusion is critical for managing hemorrhagic shock, but it cannot be initiated until a large-bore IV is placed. Vascular access is necessary before any fluid or blood product administration.

C. Obtain a specimen for ABG analysis: ABGs provide valuable data on oxygenation and acid-base balance but are diagnostic rather than life-sustaining. This step is less urgent than establishing IV access for fluid resuscitation or transfusion.

D. Place a large-bore IV catheter in an upper extremity: In trauma care, rapid IV access is the top priority to allow fluid and blood product resuscitation. A large-bore catheter ensures high-volume administration, which is essential in potential hemorrhagic shock.

Rationale:

A. Oxytocin: Oxytocin is the first-line uterotonic used to manage postpartum hemorrhage by stimulating uterine contractions to reduce bleeding. It is safe for use in clients with preeclampsia and does not elevate blood pressure.

B. Methylergonovine: Methylergonovine is contraindicated in clients with preeclampsia or hypertension because it causes vasoconstriction, which can dangerously elevate blood pressure and increase the risk of stroke or seizure.

C. Carboprost: Although carboprost is effective for postpartum hemorrhage, it should be used cautiously in clients with hypertension. It can cause bronchospasm and elevate blood pressure, which may worsen preeclampsia symptoms.

D. Nifedipine: Nifedipine is a calcium channel blocker used for managing hypertension and preterm labor. It is not indicated for treating postpartum hemorrhage as it lacks uterotonic effects.