A nurse suspects that a pregnant client may be experiencing placenta abruption based on assessment of which finding? Select all that apply.

Absence of pain

Insidious onset

Dark red vaginal bleeding

Rigid uterus

Answer and Explanation

Correct Answer : C,D,E

Choice A: Absence of pain is not a sign of abruptio placenta. Abruptio placenta is a condition where the placenta separates from the uterine wall before delivery, causing bleeding and pain. The pain is usually severe and constant.

Choice B: Insidious onset is not a sign of abruptio placenta. Abruptio placenta is usually a sudden and acute event that occurs in the third trimester or during labor.

Choice C: Dark red vaginal bleeding is a sign of abruptio placenta. The bleeding is caused by the rupture of blood vessels between the placenta and the uterus. The blood may be dark red because it is old or clotted.

Choice D: Rigid uterus is a sign of abruptio placenta. The uterus becomes hard and tense as a result of the bleeding and contraction of the uterine muscles. This can impair the blood flow to the fetus and cause fetal distress.

Choice E: Absent fetal heart tones is a sign of abruptio placenta. The loss of blood and oxygen to the fetus can cause fetal death or stillbirth. Fetal heart tones can be detected by using a Doppler device or a fetoscope.
Placenta abruption | Pregnancy Birth and Baby

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Correct Answer is C

Explanation

Choice A Reason: This is incorrect because administering Rho(D) immune globulin 24 hours before delivery is too early and may not provide adequate protection for the fetus. Administering it 24 hours after delivery is too late and may not prevent the mother from developing antibodies against the fetal Rh-positive blood cells.

Choice B Reason: This is incorrect because administering Rho(D) immune globulin in the first trimester is unnecessary and may not be effective, as the risk of Rh isoimmunization is very low before 28 weeks of gestation. Administering it within 2 hours of delivery is appropriate, but not sufficient, as it should be repeated within 72 hours after delivery.

Choice C Reason: This is correct because administering Rho(D) immune globulin at 28 weeks gestation and again within 72 hours after delivery is the recommended schedule for preventing Rh isoimmunization in Rh-negative pregnant women who have Rh-positive partners. This regimen can prevent up to 99% of cases of Rh isoimmunization by blocking the maternal immune response to the fetal Rh-positive blood cells.

Choice D Reason: This is incorrect because administering Rho(D) immune globulin at 32 weeks gestation is too late and may not prevent Rh isoimmunization if there has been any fetal-maternal hemorrhage before that time. Administering it immediately before discharge is also too late and may not prevent the mother from developing antibodies against the fetal Rh-positive blood cells.

A. Cervical insufficiency B. Uterine fibroids C. Fetal genetic abnormalities D. Maternal disease

Correct Answer is C

Explanation

Choice A Reason: This is incorrect because cervical insufficiency is a condition where the cervix dilates prematurely and painlessly during pregnancy, leading to preterm delivery or second trimester abortion. It is not a common cause of first trimester abortion, which occurs before 12 weeks of gestation.

Choice B Reason: This is incorrect because uterine fibroids are benign tumors that grow in or on the uterus. They may cause heavy bleeding, pain, or infertility, but they are not a common cause of first trimester abortion. They may increase the risk of miscarriage in later stages of pregnancy.

Choice C Reason: This is correct because fetal genetic abnormalities are the most common cause of first trimester abortion, accounting for up to 70% of cases. Fetal genetic abnormalities are errors in the number or structure of chromosomes that occur during fertilization or cell division. They can cause developmental defects or fetal demise that result in spontaneous abortion.

Choice D Reason: This is incorrect because maternal disease is not a common cause of first trimester abortion. Maternal disease refers to any medical condition that affects the mother's health or pregnancy outcome, such as diabetes, hypertension, thyroid disorders, or infections. Maternal disease may increase the risk of miscarriage in later stages of pregnancy or cause other complications such as preterm labor or preeclampsia.

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A nurse suspects that a pregnant client may be experiencing placenta abruption based on assessment of which finding? Select all that apply.

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Naxlex Comprehensive Predictor Exams

It is determined that a client's blood Rh is negative and her partner's is positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time?

Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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