A nurse is reviewing the electronic medical record (EMR) of a client who is in the labor and delivery triage unit. Nurses' Notes 1700: Client is 38-weeks of gestation and reports recent onset of uterine contractions, dark red vaginal bleeding, and abdominal pain that started approximately 1 hour prior to arrival. Client reports taking prescribed prenatal vitamins and methyldopa that is prescribed orally twice per day. 1730: Physical Exam: Past Medical History: Gestational hypertension General: anxious Cardiovascular: S1, S2, no murmur Respiratory: bilateral lung sounds clear Abdomen: hard and rigid, uterine hypertonicity, tenderness upon palpation to left upper quadrant. Toco and ultrasound transducer applied. FHR 140/min. Genitourinary: Mild amount of dark red blood noted on the perineal pad For each of the client's findings from the EMR, click to specify if the finding is consistent with placenta previa or abruptio placenta. Each finding may support more than 1 condition. There must be at least 1 selection in every column. There does not need to be a selection in every row.

Uterine tone

Vaginal bleeding characteristics

Pain rate

Client weeks of gestation

Answer and Explanation

The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A,B"}}

•   Uterine tone
o   Placenta previa: Not typically associated with abnormal uterine tone.
o   Abruptio placenta: Associated with hard and rigid abdomen, uterine hypertonicity, and tenderness.
•   Vaginal bleeding characteristics
o   Placenta previa: Typically characterized by bright red, painless vaginal bleeding.
o   Abruptio placenta: Often associated with dark red, painful vaginal bleeding.
•   Pain rate
o   Placenta previa: Usually presents with minimal or no pain.
o   Abruptio placenta: Associated with sudden, severe abdominal pain and tenderness.
•   Client weeks of gestation
o   Placenta previa: Commonly diagnosed later in pregnancy, around 30 weeks or later.
o   Abruptio placenta: Can occur at any point after 20 weeks of gestation, but often seen closer to term.

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Correct Answer is A

Explanation

A. Abruptio placentae: Correct. Continuous abdominal pain and vaginal bleeding, especially in a client with a history of cocaine use, suggest abruptio placentae. Cocaine use is a significant risk factor for this condition, where the placenta detaches prematurely from the uterine wall.

B. Hydatidiform mole: Incorrect. Hydatidiform mole, or molar pregnancy, typically presents with abnormal vaginal bleeding early in pregnancy, not at 38 weeks of gestation.

C. Preterm labor: Incorrect. While preterm labor can involve abdominal pain and bleeding, the specific combination of continuous abdominal pain and vaginal bleeding with a history of cocaine use is more indicative of abruptio placentae.

D. Placenta previa: Incorrect. Placenta previa generally causes painless bleeding, not continuous abdominal pain. It also usually presents earlier in pregnancy.

A. "Retract the foreskin until you feel resistance." B. "Use a cotton swab to clean under the foreskin." C. "Apply petroleum jelly to the foreskin." D. "Wash the penis once per day with soap and water."

Correct Answer is D

Explanation

A. Incorrect. The foreskin should not be retracted forcibly, as this can cause pain or injury. It should only be gently retracted if the child allows it.

B. Incorrect. Using a cotton swab is not recommended as it can cause irritation. Cleaning should be done gently with the foreskin in its natural position.

C. Incorrect. Petroleum jelly is not necessary or recommended for uncircumcised care and may cause irritation.

D. Correct. Washing the penis once per day with soap and water is adequate for hygiene. The foreskin should not be retracted or cleaned aggressively.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is at 38 weeks of gestation and is experiencing continuous abdominal pain and vaginal bleeding. The client has a history of cocaine use. The nurse should identify that the client is likely experiencing which of the following complications?

Correct Answer is A

Explanation

A nurse is teaching the parents of a newborn how to care for their child's uncircumcised penis. Which of the following instructions should the nurse include?

Correct Answer is D

Explanation

A nurse is caring for a client who gave birth 4 hr ago and is experiencing excessive vaginal bleeding. Which of the following actions should the nurse plan to take first?

A nurse is caring for a client who has a prescription for ibuprofen to treat postpartum cramping. Which of the following questions should the nurse ask prior to administering the medication? (Select all that apply.)

A nurse is admitting a client who is at 35 weeks of gestation and is experiencing mild vaginal bleeding due to placenta previa. Which of the following actions should the nurse plan to take?

A nurse is assessing a client who gave birth 12 hr ago and is experiencing excessive vaginal bleeding. Which of the following findings indicates the client is experiencing decreased cardiac output?

A nurse is providing teaching to a client who is at 34 weeks of gestation and is scheduled for a nonstress test. Which of the following statements should the nurse plan to make?

A nurse is assessing a client who is at 31 weeks of gestation and is receiving magnesium sulfate via continuous IV infusion for preterm labor. Which of the following findings should the nurse report to the provider?

A nurse is teaching a pregnant client who is Rh-negative about Rho(D) immune globulin. Which of the following statements by the client indicates an understanding of the teaching?