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 ["B","C","D","E"]

Explanation

Choice A Reason: This is incorrect because ultrasound visualization of the fetus is a positive sign of pregnancy, not a probable sign. A positive sign of pregnancy is a direct and definitive evidence of the presence of a fetus, such as fetal movement felt by the examiner or fetal heart sounds heard by a Doppler device.

Choice B Reason: This is correct because softening of the cervix, also known as Goodell's sign, is a probable sign of pregnancy. A probable sign of pregnancy is a strong indication of pregnancy based on physical changes in the reproductive organs, such as enlargement of the uterus or changes in the shape and consistency of the cervix.

Choice C Reason: This is correct because a positive pregnancy test, which detects human chorionic gonadotropin (hCG) in urine or blood, is a probable sign of pregnancy. However, it is not a conclusive sign, as hCG can also be produced by other conditions such as ectopic pregnancy, molar pregnancy, or trophoblastic tumors.

Choice D Reason: This is correct because absence of menstruation, also known as amenorrhea, is a probable sign of pregnancy. It occurs when ovulation and menstruation cease due to hormonal changes during pregnancy. However, it is not a definitive sign, as amenorrhea can also be caused by other factors such as stress, illness, or hormonal imbalances.

Choice E Reason: This is correct because ballottement, which is a rebounding of the fetus against the examiner's fingers during a pelvic examination, is a probable sign of pregnancy. It can be felt around 16 to 20 weeks of gestation.

Choice F Reason: This is incorrect because auscultation of a fetal heart beat, which can be heard by a fetoscope around 18 to 20 weeks of gestation or by a Doppler device around 10 to 12 weeks of gestation, is a positive sign of pregnancy, not a probable sign.

A. Breast tenderness B. Urinary frequency C. Backache D. Cravings E. Leg cramps

Correct Answer is ["A","B","D"]

Explanation

Choice A Reason: This is correct because breast tenderness is a common discomfort during the first trimester of pregnancy. It is caused by hormonal changes that stimulate breast growth and prepare them for lactation. Breast tenderness may also be accompanied by swelling, tingling, or sensitivity.

Choice B Reason: This is correct because urinary frequency is a common discomfort during the first trimester of pregnancy. It is caused by hormonal changes that increase blood flow to the kidneys and bladder, as well as by the growing uterus that puts pressure on the bladder. Urinary frequency may also be associated with increased thirst or urinary tract infections.

Choice C Reason: This is incorrect because backache is not a common discomfort during the first trimester of pregnancy. It usually occurs in later stages of pregnancy, when the weight of the fetus and the uterus shifts the center of gravity and strains the back muscles and ligaments. Backache may also be caused by poor posture, stress, or fatigue.

Choice D Reason: This is correct because cravings are a common discomfort during the first trimester of pregnancy. They are caused by hormonal changes that affect the sense of taste and smell, as well as by emotional or psychological factors. Cravings may vary from person to person and may include foods that are sweet, salty, sour, or spicy.

Choice E Reason: This is incorrect because leg cramps are not a common discomfort during the first trimester of pregnancy. They usually occur in later stages of pregnancy, when there is increased pressure on the nerves and blood vessels that supply the legs. Leg cramps may also be caused by dehydration, electrolyte imbalance, or muscle fatigue.

View Question and Answer

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

A woman comes to the prenatal clinic suspecting that she is pregnant, and assessment reveals probable signs of pregnancy. Which findings would the nurse most likely assess? Select all that apply.

Correct Answer is ["B","C","D","E"]

Explanation

A nurse is teaching a pregnant client in her first trimester about discomforts that she may experience. The nurse determines that the teaching was successful when the woman identifies which discomforts as common during the first trimester? Select all that apply.

Correct Answer is ["A","B","D"]

Explanation

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