The nurse is preparing for the admission of a 30 weeks' gestation patient experiencing vaginal bleeding with a suspected diagnosis of placenta previa. In anticipating the patient's needs, which of the following would be most appropriate for the nurse to include? Select all that apply.

Obtain equipment to start a 24-hour urine test on the patient.

Obtain equipment for a manual pelvic exam.

Prepare to draw blood for a hemoglobin and hematocrit.

Obtain equipment for external electronic fetal heart rate monitoring.

Prepare the patient for an ultrasound.

Answer and Explanation

Correct Answer : C,D,E

A. Obtain equipment to start a 24-hour urine test on the patient. A 24-hour urine test is not necessary for placenta previa. It is more commonly used for preeclampsia to assess proteinuria, which is unrelated to placenta previa.

B. Obtain equipment for a manual pelvic exam. A manual pelvic exam is contraindicated in placenta previa because it can cause further disruption of the placenta, leading to severe hemorrhage. Instead, diagnosis should be confirmed using ultrasound.

C. Prepare to draw blood for a hemoglobin and hematocrit. Hemoglobin and hematocrit levels must be monitored due to the risk of maternal hemorrhage in placenta previa. Significant blood loss can lead to anemia and may require blood transfusions.

D. Obtain equipment for external electronic fetal heart rate monitoring. Continuous fetal monitoring is essential in placenta previa to assess for signs of fetal distress. External monitoring is preferred to avoid vaginal examinations, which could worsen bleeding.

E. Prepare the patient for an ultrasound. Ultrasound is the diagnostic test of choice for placenta previa. It helps determine the exact location of the placenta and confirms whether it is covering the cervix. A transabdominal ultrasound is performed first, followed by a transvaginal ultrasound if necessary.

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Correct Answer is ["A","C"]

Explanation

A. Pitocin. Pitocin (oxytocin) is the primary medication used for labor induction. It stimulates uterine contractions to initiate or augment labor. It is given intravenously (IV) and carefully titrated to avoid complications like uterine tachysystole and fetal distress.

B. Methergine. Methergine (methylergonovine) is not used for labor induction. It is a uterotonic medication used postpartum to prevent or treat postpartum hemorrhage by causing sustained uterine contractions. It is contraindicated in pregnancy due to the risk of excessive uterine contractions and hypertension.

C. Misoprostol. Misoprostol (Cytotec) is a prostaglandin used for cervical ripening and labor induction. It is administered vaginally or orally to soften the cervix and stimulate contractions before starting Pitocin. It is commonly used in women with an unfavorable cervix.

D. Magnesium Sulfate. Magnesium sulfate is not used for labor induction. It is primarily used for seizure prevention in preeclampsia/eclampsia and to stop preterm labor (tocolysis). It actually relaxes the uterus, which is the opposite of what is needed for induction.

E. Betamethasone. Betamethasone is a corticosteroid used to accelerate fetal lung maturity in preterm labor (before 34 weeks). It has no role in labor induction.

A. Right Sided Epigastric pain B. Uterine contractions C. Bright red painless vaginal bleeding D. Severe headache E. Visual disturbances F. Dull back ache

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

Explanation

A. Right-sided epigastric pain. Epigastric pain, especially on the right side, is a concerning sign of preeclampsia and may indicate liver involvement due to elevated liver enzymes or HELLP syndrome. This symptom should be assessed further as it suggests worsening disease progression.

B. Uterine contractions. Uterine contractions are not a defining feature of preeclampsia. They are more commonly associated with preterm labor rather than hypertension-related complications. While preeclampsia can lead to preterm birth, contractions alone do not confirm or negate the condition.

C. Bright red painless vaginal bleeding. Bright red painless vaginal bleeding is more indicative of placenta previa or another obstetric complication rather than preeclampsia. Preeclampsia primarily presents with hypertension, proteinuria, and systemic symptoms rather than vaginal bleeding.

D. Severe headache. A severe headache is a classic symptom of preeclampsia, often due to elevated blood pressure and cerebral edema. Persistent headaches that do not resolve with usual interventions should be evaluated promptly as they may indicate worsening hypertension or an impending seizure.

E. Visual disturbances. Visual disturbances such as blurred vision, photophobia, or seeing spots are common in preeclampsia and can signal cerebral edema or increased intracranial pressure. This is a significant warning sign requiring immediate assessment.

F. Dull backache. A dull backache is more commonly associated with musculoskeletal strain, labor, or a urinary tract infection rather than preeclampsia. While discomfort can be present in pregnancy, it is not a defining symptom of preeclampsia.

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The nurse is preparing for the admission of a 30 weeks' gestation patient experiencing vaginal bleeding with a suspected diagnosis of placenta previa. In anticipating the patient's needs, which of the following would be most appropriate for the nurse to include? Select all that apply.

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Correct Answer is ["A","C"]

Explanation

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