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
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.
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Related Questions
Correct Answer is C
Explanation
Choice A Reason: This option is incorrect because it is unrealistic and impractical to eliminate anxiety completely. Anxiety is a normal and natural response to pregnancy and childbirth, and it can have both positive and negative effects on the outcome. Anxiety can motivate women and their partners to seek information and care, but it can also interfere with their ability to relax and cope with pain. Perinatal education can help them manage their anxiety by providing accurate information, reassurance, and coping strategies.
Choice B Reason: This option is incorrect because it implies that the couple has no control over their pregnancy and birth unless they are empowered by perinatal education. While perinatal education can enhance their sense of control and autonomy, it is not the only factor that influences their experience. Pregnancy and birth are complex and dynamic processes that involve many factors beyond their control, such as biological, environmental, social, and cultural factors. Perinatal education can help them adapt to these factors and collaborate with their health care providers.
Choice C Reason: Perinatal education is a process of providing information and support to pregnant women and their partners before, during, and after childbirth. The main goal of perinatal education is to help them prepare for a positive birth experience, which can have lasting benefits for their physical and emotional health, as well as their relationship with their baby. Perinatal education can also help them make informed decisions about their care and preferences, and cope with any challenges or complications that may arise.
Choice D Reason: This option is incorrect because it is too narrow and limited in scope. Providing knowledge and skills that will help them cope with labor is an important aspect of perinatal education, but it is not the primary goal. Labor is only one stage of childbirth, and perinatal education covers a broader range of topics that are relevant for pregnancy, birth, and postpartum. Moreover, coping with labor is not the only outcome that matters for a positive birth experience. Perinatal education can also help them achieve other outcomes, such as satisfaction, empowerment, bonding, and well-being.
Correct Answer is B
Explanation
Choice A Reason: This option is incorrect because it underestimates the number of pregnancies (gravida) and overestimates the number of preterm births (preterm). The client has had four pregnancies (twins count as one pregnancy), not three. The client has had one preterm birth (the twins), not two.
Choice B Reason: This option is correct because it accurately reflects the client's obstetric history. GTPAL stands for Gravida, Term, Preterm, Abortions, and Living children. Gravida is the number of pregnancies a woman has had, regardless of outcome. Term is the number of pregnancies that ended at or beyond 37 weeks gestation. Preterm is the number of pregnancies that ended between 20 and 36 weeks gestation. Abortions are the number of pregnancies that ended before 20 weeks gestation, either spontaneously or induced. Living children are the number of children who are alive at present.
The client has had four pregnancies (gravida), one term birth (the son), one preterm birth (the twins), one abortion (the miscarriage), and three living children (the twins and the son).
Choice C Reason: This option is incorrect because it overestimates the number of preterm births (preterm) and underestimates the number of living children (living). The client has had one preterm birth (the twins), not two. The client has three living children (the twins and the son), not one.
Choice D Reason: This option is incorrect because it underestimates the number of pregnancies (gravida) and overestimates the number of abortions (abortions) and preterm births (preterm). The client has had four pregnancies (twins count as one pregnancy), not three. The client has had one abortion (the miscarriage), not two. The client has had one preterm birth (the twins), not two.
