A nurse is collecting data from a client who has placenta previa.
Which of the following findings should the nurse expect?
Rigid abdomen.
Persistent uterine contractions.
Bright red vaginal bleeding.
Increased fetal movement.
The Correct Answer is C
Choice A rationale:
Rigid abdomen. A rigid abdomen is not typically associated with placenta previa. Placenta previa is a condition in which the placenta partially or completely covers the cervix, and it is more likely to present with painless vaginal bleeding rather than abdominal rigidity.
Choice B rationale:
Persistent uterine contractions. Persistent uterine contractions are not a characteristic finding in placenta previa. In fact, uterine contractions can be concerning in the presence of placenta previa as they may increase the risk of bleeding.
Choice C rationale:
Bright red vaginal bleeding. Bright red vaginal bleeding is a common and hallmark symptom of placenta previa. This bleeding typically occurs without pain and can be intermittent or continuous. It is essential to recognize this symptom promptly because it can lead to significant maternal and fetal complications.
Choice D rationale:
Increased fetal movement. Increased fetal movement is not a typical finding in placenta previa. The presence or absence of fetal movement should always be monitored during pregnancy, but it is not a specific indicator of placenta previa.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
"I will notify my doctor if the stoma starts to look purple" indicates an understanding of the importance of monitoring the colostomy site for signs of compromised blood flow or ischemia. A purple or bluish color of the stoma may suggest reduced blood supply, which is a critical concern and should be reported promptly to the healthcare provider.
Choice B rationale:
"I should expect my stool to be formed" is incorrect. In a colostomy, the type of stool output will depend on the location of the colostomy and the surgical procedure performed. Stool consistency can vary, and it may be formed or semi-formed depending on the individual and the specific situation. Expecting formed stool may not always be accurate.
Choice C rationale:
"I will no longer be able to eat nuts" is not necessarily true for all individuals with a colostomy. While some people may experience digestive difficulties with certain foods, including nuts, it is not a universal rule. Dietary restrictions should be discussed with a healthcare provider or a registered dietitian based on the individual's specific condition and needs.
Choice D rationale:
"I will irrigate the colostomy every day" is not a recommended practice for all colostomy patients. Colostomy irrigation is a procedure that may be performed by some individuals with descending or sigmoid colostomies to regulate bowel movements. However, it is not necessary or appropriate for all colostomy patients. The need for colostomy irrigation should be determined by the healthcare provider and discussed with the patient as part of their individualized care plan.
Correct Answer is C
Explanation
Choice A rationale:
Hypercalcemia. Hypercalcemia refers to an elevated level of calcium in the blood. It is not typically a concern in a newborn, and monitoring for hypercalcemia is not necessary in this context. The infant's weight and maternal diabetes are more relevant factors to consider.
Choice B rationale:
Hypobilirubinemia. Hypobilirubinemia implies a low level of bilirubin in the blood, which is not a common concern in newborns, especially in the context of a newborn's weight and maternal diabetes. Monitoring for hyperbilirubinemia, which can lead to jaundice, would be more appropriate.
Choice C rationale:
Hypoglycemia. Hypoglycemia, or low blood sugar, is a significant concern in newborns of diabetic mothers. Newborns born to diabetic mothers are at increased risk of hypoglycemia due to the abrupt cessation of the continuous glucose supply from the mother's bloodstream after birth. Monitoring the newborn's blood glucose levels is crucial in this case.
Choice D rationale:
Decreased RBC. Monitoring for decreased red blood cell (RBC) counts is not typically a primary concern in a newborn, especially one born to a diabetic mother. Hypoglycemia, which can be a result of maternal diabetes, poses a more immediate and significant threat to the newborn's well-being.
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