A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which of the following findings support this diagnosis?

Painless red vaginal bleeding

Intermittent abdominal pain following passage of bloody mucus

Increasing abdominal pain with a nonrelaxed uterus

Abdominal pain with scant red vaginal bleeding

Answer and Explanation

The Correct Answer is A

Choice A reason: Painless red vaginal bleeding is the most characteristic finding of placenta previa, which is a condition where the placenta covers the cervical opening and can cause bleeding in the third trimester. Painless red vaginal bleeding occurs because the placenta is detached from the lower uterine segment as the cervix dilates or effaces, and the blood vessels are torn. The bleeding can be mild or severe, and it can recur or persist until delivery.

Choice B reason: Intermittent abdominal pain following passage of bloody mucus is not a finding that supports placenta previa, but rather a finding that suggests normal labor or preterm labor. Intermittent abdominal pain is caused by uterine contractions, which can be regular or irregular, and can increase in frequency, duration, and intensity. Bloody mucus is the mucus plug that is expelled from the cervix as it dilates or effaces, and it can be tinged with blood or streaked with blood.

Choice C reason: Increasing abdominal pain with a nonrelaxed uterus is not a finding that supports placenta previa, but rather a finding that indicates abruptio placentae, which is a premature separation of the placenta from the uterine wall. Increasing abdominal pain is caused by the bleeding and the hematoma formation behind the placenta, which can compress the uterine muscle and the nerve endings. Nonrelaxed uterus is a sign of uterine hypertonicity, which can reduce the blood flow and the oxygen delivery to the fetus.

Choice D reason: Abdominal pain with scant red vaginal bleeding is not a finding that supports placenta previa, but rather a finding that suggests ectopic pregnancy, which is a condition where the fertilized ovum implants outside the uterine cavity, usually in the fallopian tube. Abdominal pain is caused by the rupture of the tube and the bleeding into the peritoneal cavity, which can irritate the diaphragm and the abdominal wall. Scant red vaginal bleeding is a sign of implantation bleeding, which can occur when the fertilized ovum attaches to the tube wall.

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Correct Answer is C

Explanation

Choice A reason: Prostaglandin E2 is not an appropriate medication for the client, because it is a uterotonic agent that stimulates uterine contractions and cervical ripening. Prostaglandin E2 is used to induce labor, not to stop it.

Choice B reason: Methylergonovine is not an appropriate medication for the client, because it is a uterotonic agent that causes sustained uterine contractions and vasoconstriction. Methylergonovine is used to prevent or treat postpartum hemorrhage, not to stop preterm labor.

Choice C reason: Terbutaline is an appropriate medication for the client, because it is a tocolytic agent that relaxes the uterine smooth muscle and inhibits contractions. Terbutaline is used to delay preterm labor and prolong pregnancy.

Choice D reason: Oxytocin is not an appropriate medication for the client, because it is a uterotonic agent that stimulates uterine contractions and milk ejection. Oxytocin is used to augment labor, not to stop it.

A. Meconium aspiration, hypoglycemia, and dry, cracked skin B. Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance C. Excessive vernix caseosa covering the skin, lethargy, and RDS D. Golden yellow to green-stained skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat

Correct Answer is A

Explanation

Choice A reason: This statement is correct, as these are the common complications of post-term infants, who are born after 42 weeks of gestation. Meconium aspiration can occur when the fetus passes meconium in utero and inhales it into the lungs, causing respiratory distress, inflammation, and infection. Hypoglycemia can occur due to the depletion of glycogen stores and the increased metabolic demands. Dry, cracked skin can occur due to the loss of vernix caseosa and the reduced amniotic fluid.

Choice B reason: This statement is incorrect, as these are the signs of neonatal hypocalcemia, which is a low level of calcium in the blood. Neonatal hypocalcemia can occur due to maternal diabetes, prematurity, or asphyxia, and can cause jitteriness, seizures, or tetany.

Choice C reason: This statement is incorrect, as these are the characteristics of preterm infants, who are born before 37 weeks of gestation. Excessive vernix caseosa covering the skin is a protective coating that prevents heat and water loss. Lethargy and RDS are signs of immaturity and underdevelopment of the central nervous system and the lungs.

Choice D reason: This statement is incorrect, as these are the features of infants with erythroblastosis fetalis, which is a hemolytic disease caused by the incompatibility of the Rh factor or the ABO blood group between the mother and the fetus. Golden yellow to green-stained skin and nails are due to the accumulation of bilirubin, which is a breakdown product of red blood cells. Absence of scalp hair and an increased amount of subcutaneous fat are due to the chronic hypoxia and edema.

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A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which of the following findings support this diagnosis?

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