A nurse is teaching a client who is at 15 weeks of gestation and is to undergo an amniocentesis. The nurse should explain that the purpose of this test is to identify which of the following conditions? (Select all that apply.)

Explanation:

A. Placenta previa:

Placenta previa is a condition where the placenta partially or completely covers the cervix. It typically presents with painless, bright red vaginal bleeding, especially after 20 weeks of gestation. However, it is not usually associated with sudden, continuous abdominal pain. Instead, placenta previa is known for painless bleeding episodes, which can be severe but intermittent. Therefore, placenta previa is less likely to be the cause of the client's sudden abdominal pain and bleeding in this scenario.

B. Incompetent cervix:

Incompetent cervix, also known as cervical insufficiency, is a condition where the cervix begins to dilate and efface prematurely, often leading to preterm birth. While incompetent cervix can result in painless vaginal discharge or light bleeding, it typically does not cause sudden, continuous abdominal pain and significant vaginal bleeding. Additionally, incompetent cervix is more commonly diagnosed earlier in pregnancy, usually in the second trimester. Therefore, it is less likely to be the cause of the client's symptoms in the third trimester.

C. Abruptio placentae:

Abruptio placentae refers to the premature separation of the placenta from the uterine wall before delivery. It is associated with sudden, severe abdominal pain and vaginal bleeding. The bleeding may be concealed (hidden behind the placenta) or external, depending on the degree of separation. Abruptio placentae is a medical emergency that requires prompt intervention to prevent complications for both the mother and fetus. Given the sudden onset of continuous abdominal pain and vaginal bleeding in a client with pregnancy-induced hypertension, abruptio placentae is the most likely complication in this scenario.

D. Prolapsed cord:

Prolapsed cord occurs when the umbilical cord slips through the cervix and becomes compressed during labor or before the presenting part of the fetus. While prolapsed cord can lead to vaginal bleeding, it is not typically associated with continuous abdominal pain. Instead, prolapsed cord may cause fetal distress due to cord compression, which can manifest as abnormal fetal heart rate patterns. However, in this scenario, sudden, continuous abdominal pain is a more prominent symptom, making abruptio placentae a more likely cause.

Explanation:

A. A client who is at 28 weeks of gestation and receiving terbutaline reports fine tremors:

Fine tremors are a known side effect of terbutaline, which is often used to delay preterm labor by relaxing the uterus. While tremors are a common and expected side effect of terbutaline, they are not typically considered an urgent concern unless they are severe or accompanied by other concerning symptoms.

B. A client who has a diagnosis of preeclampsia has 2+ proteinuria and 2+ patellar reflexes:

Proteinuria (2+) and increased deep tendon reflexes (2+) are significant findings in a client with preeclampsia, indicating worsening of the condition and potential organ involvement. However, they may not require immediate reporting unless accompanied by other severe symptoms such as severe hypertension, severe headache, visual disturbances, or epigastric pain.

C. A client who has a diagnosis of preeclampsia reports epigastric pain and unresolved headache:

This is the correct answer. Epigastric pain and unresolved headache are concerning symptoms in a client with preeclampsia and can indicate worsening of the condition or complications such as HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). These symptoms may suggest liver involvement, which is a serious complication of preeclampsia and requires immediate evaluation and management by the provider.

D. A tearful client who is at 32 weeks of gestation and is experiencing irregular, frequent contractions:

While tearfulness and irregular, frequent contractions may indicate emotional distress or early labor, they are not typically considered urgent findings unless accompanied by other signs of impending preterm labor such as cervical changes or regular, painful contractions. Immediate reporting is important if there are signs of active labor or cervical changes, but based on the information provided, this finding is not as urgent as the epigastric pain and unresolved headache in a client with preeclampsia.