A nurse is collecting data from a client who has placenta previa. Which of the following findings should the nurse expect?

Bright red vaginal bleeding

Persistent uterine contractions

Increased fetal movement

Rigid abdomen

Answer and Explanation

The Correct Answer is A

A.   Correct. Placenta previa is a condition where the placenta covers part or all of the cervix.
Bright red vaginal bleeding, especially painless bleeding, is a hallmark sign of placenta previa.
B.   Incorrect. Persistent uterine contractions are not a typical finding in placenta previa and could indicate preterm labor or other issues.
C.   Incorrect. Increased fetal movement is not a characteristic sign of placenta previa.
D.   Incorrect. A rigid abdomen is not associated with placenta previa; it could be a sign of other conditions such as placental abruption.

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Correct Answer is B

Explanation

A. "I will take two 325 milligram aspirin tablets at the same time.": While aspirin is often recommended for heart attack prevention, taking two 325 mg tablets at the same time is not the standard recommendation for managing stable angina. The client should focus on using nitroglycerin as prescribed and seeking immediate medical attention if symptoms persist.

B. "I will stop what I am doing and lie down.": When chest pain occurs, the client should stop all activity and rest, preferably lying down. Resting can help reduce the heart's workload and alleviate the pain associated with stable angina.

C. "I will call the provider after taking one dose of nitroglycerin.": The correct action is to take one dose of nitroglycerin and wait five minutes. If the pain is not relieved, the client should take another dose and wait another five minutes. If the pain persists after three doses, the client should seek emergency medical help immediately rather than waiting to call the provider.

D. "I will hold my breath and bear down.": Holding the breath and bearing down (the Valsalva maneuver) is not recommended for relieving chest pain. This action can actually decrease venous return to the heart and increase strain on the heart, potentially worsening the situation.

A. Apply the restraint under the client's clothes. B. Place the client in a sitting position. C. Tie the restraint to the railing of the client's bed. D. Ensure the restraint is placed across the client's chest.

Correct Answer is B

Explanation

A.Restraints should never be applied directly on the skin or under clothing, as this can cause irritation, pressure injuries, and make it difficult for the nurse to assess skin integrity. Restraints should be placed over the client's clothing to reduce friction and protect the skin.

B.Positioning the client in a sitting or semi-Fowler's position is preferred as it promotes comfort, minimizes the risk of aspiration, and allows the nurse to monitor the client's airway, breathing, and circulation more effectively. Lying flat can increase discomfort and respiratory difficulty, especially if the client is aggressive or agitated.

C.Restraints should never be tied to movable parts, like bed rails, as this could result in injury if the bed rail is moved up or down. Restraints should be tied to a non-movable part of the bed frame to ensure stability and prevent accidental tightening or loosening that could harm the client.

D.A belt restraint should be placed across the client’s waist or hips, not the chest, as a chest restraint can impede respiratory function, especially in an aggressive client who may be physically exerting themselves. The restraint should secure the client’s lower body to prevent them from standing or moving excessively, while still allowing safe breathing and circulation.

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A nurse is collecting data from a client who has placenta previa. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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