A nurse is collecting data from a client who has placenta previa. Which of the following findings should the nurse expect?
Increased fetal movement
Persistent uterine contractions
Rigid abdomen
Bright red vaginal bleeding
The Correct Answer is D
Bright red vaginal bleeding
Placenta previa is a condition in which the placenta partially or completely covers the opening of the cervix. One of the hallmark findings of placenta previa is painless, bright red vaginal bleeding, typically occurring in the later stages of pregnancy. This bleeding can be sudden and heavy or intermittent. It is important for the nurse to recognize this sign and promptly report it to the healthcare provider.
Increased fetal movement in (option A) is incorrect: Fetal movement is not directly related to placenta previa and may vary depending on the individual fetus.
Persistent uterine contractions in (option B): Persistent uterine contractions are more commonly associated with conditions such as preterm labour or uterine irritability, rather than placenta previa.
Rigid abdomen in (option C): A rigid abdomen may indicate uterine hypertonus or other complications, but it is not a specific finding of placenta previa.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D"]
Explanation
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Assist the client with a bath: The client is independently transferring out of bed and ambulating in the hallway. Since they are managing personal mobility well, there is no immediate need for assistance with bathing, and this does not address the client’s most pressing issues.
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Encourage oral fluid intake: The client is experiencing hard, painful bowel movements and abdominal cramping, which are signs of constipation. Increased oral fluid intake can help soften stool and promote more regular bowel movements, making this a supportive and appropriate intervention.
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Irrigate indwelling catheter with 500 mL of fluid: The client is voiding 100 mL/hr of pink urine, which is a normal finding in the early postoperative period and does not suggest catheter obstruction. Therefore, irrigation is not indicated and could introduce infection unnecessarily.
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Administer an enema: The client reports painful, incomplete bowel elimination and abdominal cramping, which may indicate constipation or fecal impaction. Administering an enema is an appropriate intervention to relieve discomfort and promote bowel evacuation.
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Encourage prolonged dangling before ambulation: The client is already ambulating independently in the hallway, indicating they are tolerating activity well. There is no evidence of orthostatic intolerance, so prolonged dangling is not necessary.
Correct Answer is C
Explanation
This response demonstrates a therapeutic and non-judgmental approach, allowing the client to express their concerns, fears, or reasons for refusing to learn how to self-administer insulin. It promotes open communication and understanding between the nurse and the client, providing an opportunity to address any misconceptions, fears, or barriers the client may have. By actively listening to the client's perspective, the nurse can better tailor the education and support provided, ultimately helping the client make informed decisions regarding their healthcare.
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