A client who is 35-weeks pregnant arrives at the emergency department complaining of heavy, painful vaginal bleeding.
It would be a priority for the nurse to monitor the client for
A client who is 35-weeks pregnant arrives at the emergency department complaining of heavy, painful vaginal bleeding.
It would be a priority for the nurse to monitor the client for
A. abruptio placentae.
[83%]
B. placenta previa.
[12%]
C. prelabor rupture of the membranes.
[5%]
D. passage of the mucus plug.
[0%]
Statistics
Subject/Lesson
Subject
Maternal & Newborn Health
Lesson
Antepartum
Client Need
Test Plan
Physiological Adaptation
Related Topic
Alterations in Body Systems
Item Type
Item Type
Application
Explanation
Choice A is correct. Here, the nurse should immediately suspect abruptio placentae, as this client presents with the classic signs of severe pain and vaginal bleeding. Abruptio placentae (called abruptio placentae, placental abruption, or premature separation of the placenta) is the premature separation of a normally implanted placenta from the uterus. Placental abruption presents a significant risk for both the woman and the fetus. Once the premature placental separation begins, the woman becomes at risk for hemorrhage and consequent hypovolemic shock and clotting abnormalities. Similarly, risks to the fetus include asphyxia, excessive blood loss, prematurity, and fetal demise.
Choice B is incorrect. Placenta previa is the implantation of the placenta in the lower uterus. The classic sign of placenta previa is the sudden onset of painless uterine bleeding. In the above scenario, the client presents with "heavy, painful vaginal bleeding," which is not in congruence with a classic placenta previa client presentation.
Choice C is incorrect. Prelabor rupture of membranes (PROM) is leakage of amniotic fluid before the onset of labor. Typically, unless complications occur, the only symptom of PROM is leakage or a sudden gush of amniotic fluid from the vagina. The above client's complaints do not align with PROM.
Choice D is incorrect. Most women do not realize they have lost their mucus plug. If a woman does, a mucus plug will often appear similar to vaginal discharge in one's underwear and not contain blood.
Related Videos
2 Key Topics
Abruptio Placentae
30.4 Intrapartum Complications
Additional Info
✓ Abruptio placenta is a true obstetric emergency.
✓ The severity of symptoms and signs depends on the degree of separation of the placenta from the uterus and the amount of blood loss.
✓ Abruptio placentae and other obstetric abnormalities increase the risk of morbidity or mortality for the woman, fetus, or neonate.
✓ Vaginal bleeding in placental abruption may be external or concealed (i.e., retained).
