Share This Link

A prolapsed cord is an obstetric emergency where the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. It’s a rare condition but can occur during labor if the baby is not yet engaged, and the water breaks. The main concern is that the cord can become compressed, cutting off the baby’s oxygen supply. However, it does not typically present with continuous abdominal pain and vaginal bleeding without labor.

Premature rupture of membranes (PROM) refers to a patient whose membranes have ruptured before the onset of labor. While PROM can lead to complications, it is not typically associated with continuous abdominal pain and vaginal bleeding. PROM is more often characterized by the sudden release of fluid from the vagina.

 Placenta previa is a condition where the placenta covers the cervix either completely or partially. It can cause painless, bright red vaginal bleeding but is not typically associated with abdominal pain. The bleeding with placenta previa is usually not continuous but rather occurs in episodes.

In this scenario, the continuous abdominal pain and vaginal bleeding are classic signs of abruptio placentae, making Choice C the most likely diagnosis.

 Quickening does not start soon after implantation. Implantation occurs around 6-10 days after fertilization, but quickening, which is the first feeling of fetal movements, typically happens much later in pregnancy.

 Quickening does not start during the last trimester. By the last trimester, fetal movements are usually strong and frequent, and the mother has been feeling them for several months.

 Quickening does not occur between the second and third month of pregnancy. At this stage, the fetus is still too small for its movements to be felt by the mother.

Consuming any amount of alcohol during pregnancy is not recommended. Alcohol can cross the placenta and harm the developing fetus, potentially leading to fetal alcohol spectrum disorders (FASDs). FASDs can cause a range of physical, mental, and behavioral problems, including intellectual disabilities, learning disabilities, and physical abnormalities. Even small amounts of alcohol can increase the risk of FASDs, and there is no known safe amount of alcohol to consume during pregnancy.

Weight loss during pregnancy is generally not recommended unless specifically advised by a healthcare provider. Pregnancy is a time for growth and nourishment of the baby, and restricting calories or attempting to lose weight can potentially harm the developing fetus. It's important to focus on consuming a healthy, balanced diet and gaining a healthy amount of weight during pregnancy.

Consuming high amounts of caffeine during pregnancy is not recommended. Caffeine can cross the placenta and potentially affect the baby's heart rate and sleep patterns. It's generally advised to limit caffeine intake to less than 200 milligrams per day during pregnancy.

Judgmental and shaming: The statement "You are so young. Are you sure you are ready for the responsibilities of a sexual relationship?" conveys judgment and may make the adolescent feel ashamed or embarrassed. This can create a barrier to open communication and discourage the teen from seeking further guidance.

Dismisses the teen's concerns: It does not directly address the teen's question about contraception, suggesting that her concerns are not valid or important.

Does not provide helpful information: It does not offer any guidance or education about contraception, leaving the teen without the information she needs to make informed decisions about her sexual health.

Erects barriers to access: Requiring parental consent for an examination can delay or prevent the teen from obtaining contraception, even if she is legally allowed to do so without parental consent.

Discourages open communication: It may make the teen feel like she cannot trust the nurse or that her privacy will not be respected, leading her to withhold information or avoid seeking further help.

Defers responsibility: It shifts the responsibility for providing contraception counseling to the doctor, potentially delaying the teen's access to information and services.

May not be necessary: A physical examination is not always required before prescribing contraception, and in some cases, a nurse practitioner or other qualified health professional can provide this service.

Appendicitis is an inflammation of the appendix, a small, finger-shaped organ located in the lower right abdomen. It is a common cause of abdominal pain, especially in young adults.

However, the patient in this scenario is experiencing pain in the lower abdominal pelvic region, not specifically in the lower right quadrant. This makes appendicitis less likely.

Additionally, the patient does not have any other symptoms that are typically associated with appendicitis, such as fever, nausea, or vomiting.

Endometriosis is a condition in which tissue that normally lines the uterus grows outside of the uterus. It can cause pain, especially during menstruation.

However, the patient in this scenario does not report cyclical pain, which is a hallmark symptom of endometriosis. Additionally, endometriosis is not typically associated with the presence of fluid-filled sacs on the ovaries.

Pelvic inflammatory disease (PID) is an infection of the upper genital tract, including the uterus, fallopian tubes, and ovaries. It is often caused by sexually transmitted infections (STIs).

PID can cause pelvic pain, but it is also typically associated with other symptoms, such as fever, vaginal discharge, and irregular bleeding.

The patient in this scenario does not have any of these other symptoms, and her white blood cell count is not elevated, which makes PID less likely.

 Threatened abortion typically occurs in the first trimester and involves vaginal bleeding with or without abdominal pain. It is not associated with late pregnancy bleeding.

 Preterm labor involves uterine contractions leading to cervical changes before 37 weeks of gestation. While it can cause bleeding, it is usually accompanied by regular contractions and not typically described as bright red bleeding.

 Abruptio placentae involves the premature separation of the placenta from the uterine wall, leading to painful, dark red vaginal bleeding. It is often associated with abdominal pain and uterine tenderness, which differentiates it from placenta previa.

An IV is not routinely initiated prior to a non-stress test. It may be started if a biophysical profile (BPP), which includes an ultrasound, is also being performed, or if there is a risk of complications that may necessitate immediate intervention. However, it is not a standard part of the non-stress test itself.

Nipple stimulation is not a standard component of a non-stress test. It may be used in some cases to try to induce fetal movement if the fetus is not moving actively enough during the test. However, it is not a routine part of the procedure.

An ultrasound is not typically performed prior to a non-stress test. It may be done as part of a BPP, but it is not necessary for the non-stress test itself.

While fluid restriction has been a traditional recommendation for preeclampsia, current evidence does not support limiting fluid intake to 1,000 ml/day. In fact, excessive fluid restriction can lead to dehydration, which can worsen placental perfusion and compromise fetal well-being.
It's essential for women with preeclampsia to maintain adequate hydration to support essential bodily functions and fetal growth. Adequate fluid intake also helps to prevent urinary tract infections, which are more common in women with preeclampsia.

Although reducing sodium intake can be beneficial for overall blood pressure control, there's insufficient evidence to support a strict sodium restriction of 2,000 mg/day specifically for managing mild preeclampsia. Individual needs may vary, and a more moderate approach to sodium reduction is often recommended.
Focusing on a balanced, healthy diet with appropriate sodium intake is generally more effective than strict limitations. This approach promotes overall well-being and supports healthy blood pressure levels without compromising nutritional needs.

Rest is often recommended for women with preeclampsia to reduce stress on the cardiovascular system and promote placental blood flow. However, the supine position (lying on the back) is not ideal, as it can further compress the large blood vessels in the abdomen and potentially reduce blood flow to the placenta.
Side-lying positions, particularly the left lateral position, are preferred for women with preeclampsia. These positions help to alleviate pressure on the major blood vessels, enhance blood flow, and improve uteroplacental circulation, which benefits both the mother and the baby.

While whitish vaginal discharge can occur in some cases of hydatidiform mole, it's not a specific or sensitive finding for this condition.

It can also be present in various other gynecological conditions, including normal pregnancy, infections, and hormonal imbalances.

Therefore, relying on whitish vaginal discharge alone for monitoring a potential hydatidiform mole could lead to misdiagnosis or delayed diagnosis.

Excessive uterine enlargement is a common sign of hydatidiform mole, but it's not always present and might not be detected early in the condition.

The uterus might not be significantly enlarged in early stages, and other factors like multiple pregnancies or uterine fibroids could also contribute to uterine enlargement.

Solely relying on uterine enlargement could miss cases of hydatidiform mole that haven't progressed to a noticeable degree.

Fetal heart rate irregularities are not relevant in hydatidiform mole because there is no viable fetus present. Hydatidiform moles are characterized by abnormal growth of placental tissue without a normal fetus developing. Monitoring for fetal heart rate would be inappropriate and misleading in this context.