Previa/Abruption Practice Questions
A client with a complete placenta previa is on the antepartum clinical unit in preparation for delivery. Which of the following should the nurse include in a teaching session for this client? 1. Coughing and deep breathing. 2. Phases of the first stage of labor. 3. Lamaze labor techniques. 4. Leboyer hydrobirthing
1 1. Because the client will have a cesarean section with anesthesia, the woman should be taught coughing and deepbreathing exercises for the postoperative period. 2. Because the woman will not be going through labor, it is inappropriate to teach her about the phases of the first stage of labor. 3. Because the woman will not be going through labor, it is inappropriate to teach her about Lamaze breathing techniques. 4. Because the woman will not be going through labor, it is inappropriate to teach her about Leboyer hydrobirthing. TEST-TAKING TIP: When a client has a complete placenta previa, the placenta has attached to the uterine lining so that it fully covers the internal cervical os. If the woman were to go through labor, during dilation and effacement the villi of the placenta would incrementally be exposed, leading the client to bleed profusely. The baby would exsanguinate and die. The only safe way to deliver the baby, therefore, is via cesarean section
Which of the following signs/symptoms would the nurse expect to see in a woman with abruptio placentae? 1. Increasing fundal height measurements. 2. Pain-free vaginal bleeding. 3. Fetal heart accelerations. 4. Hyperthermia with leukocytosis.
1 1. Fundal heights increase during pregnancy approximately 1 cm per week. When a placental abruption occurs, the height increases hour by hour. 2. Pain-free vaginal bleeding is consistent with a diagnosis of placenta previa. 3. The nurse would expect to see late fetal heart decelerations. 4. This is not an infectious state. The nurse would not expect to see hyperthermia. TEST-TAKING TIP: When a placenta abrupts, it separates from the uterine wall. As a result, a pool of blood appears behind the placenta. The pool of blood takes up space, leading to an increase in the size of the uterus. The fundal height increases as the uterine size increases.
A client presents to the OB triage unit with no prenatal care and painless bright red vaginal bleeding. Which interventions are most indicated? 1.Applying external fetal monitor and complete physical assessment. 2.Applying external fetal monitor and perform sterile vaginal exam. 3.Obtaining a fundal height physical assessment on the patient. 4.Obtaining fundal height and a sterile vaginal exam.
1. Bright red vaginal bleeding without contractions could indicate a placenta previa. A sterile vaginal exam should never be done on a woman with a known or suspected placenta previa. Applying the external fetal monitor will allow the nurse to assess fetal status. A complete physical assessment of the patient is indicated. A fundal height is used to monitor fetal growth during pregnancy but does not provide information related to vaginal bleeding.
An obstetrician declares at the conclusion of the third stage of labor that a woman is diagnosed with placenta accreta. The nurse would expect to see which of the following signs/symptoms? 1. Hypertension. 2. Hemorrhage. 3. Bradycardia. 4. Hyperthermia
2 1. Hypertension is not related to the diagnosis of placenta accreta. 2. The nurse would expect the woman to hemorrhage. 3. Bradycardia is not related to the diagnosis of placenta accreta. 4. Hyperthermia is not related to the diagnosis of placenta accreta. TEST-TAKING TIP: A placenta accreta is present when the chorionic villi attach directly to or invade through the myometrium of the uterus. There is no way, therefore, for the placenta to separate from the uterine wall. Hemorrhage results. It is not uncommon for a hysterectomy to have to be performed to save the woman's life.
A viable male neonate born to a 28-year-old multiparous client by cesarean section because of placenta previa is diagnosed with respiratory distress syndrome (RDS). Which of the following would the nurse explain as the factor placing the neonate at the greatest risk for this syndrome? 1.Mother's development of placenta previa. 2.Neonate born preterm. 3.Mother receiving analgesia 4 hours before birth. 4.Neonate with sluggish respiratory efforts after birth
2 RDS is a developmental condition that primarily affects preterm infants before 35 weeks' gestation because of inadequate lung development from deficient surfactant production. The development of placenta previa has little correlation with the development of RDS. Although excessive analgesia can depress the neonate's respiratory condition if it is given shortly before birth, the scenario presents no information that this has occurred. The neonate's sluggish respiratory activity postpartum is not the likely cause of RDS but may be a sign that the neonate has the condition.
The doctor writes the following order for a 31-week-gravid client with symptomatic placenta previa: Weigh all vaginal pads and estimate blood loss. The nurse weighs one of the client's saturated pads at 24 grams and a dry pad at 4 grams. How many milliliters (mL) of blood can the nurse estimate the client has bled? Calculate to the nearest whole number. __________ mL
20 mL of blood TEST-TAKING TIP: 1 mL of fl uid weighs approximately 1 gram. The nurse can estimate, therefore, that the blood loss is: 24 - 4 = 20 mL of blood
The labor nurse has just received a shift report on four gravid patients. Which of the patients should the nurse assess first? 1. G5 P2202, 32 weeks, placenta previa, today's hemoglobin 11.6 g/dL. 2. G2 P0101, 39 weeks, type 2 diabetic, blood glucose (15 minutes ago) 85 mg/dL. 3. G1 P0000, 32 weeks, placental abruption, fetal heart (5 minutes ago) 120 bpm. 4. G2 P1001, 39 weeks, Rh-negative, today's hematocrit 31%
3 1. Although placenta previa is an obstetric complication, the hemoglobin is within normal limits. 2. Although diabetes mellitus is an obstetric complication, the blood glucose is within normal limits. 3. A placental abruption is a life-threatening situation for the fetus. It has been 5 minutes since the client was assessed. This is the nurse's priority. 4. A woman who is Rh-negative may or not may not be carrying a baby who is Rh-positive. Either way, a hematocrit of 31%, although low, is not an emergent value. TEST-TAKING TIP: In this question, the test taker must discriminate among four situations to discern which is the highest priority. Although a client with placenta previa is at high risk for bleeding, it is very likely that if she did start to bleed spontaneously, she would notify the nurse. A client who has a placental abruption, however, is already in a life threatening situation, both for her fetus and for herself.
A 29-week-gravid client is admitted to the labor and delivery unit with vaginal bleeding. To differentiate between placenta previa and abruptio placentae, the nurse should assess which of the following? 1. Leopold maneuver results. 2. Quantity of vaginal bleeding. 3. Presence of abdominal pain. 4. Maternal blood pressure.
3 1. Leopold maneuvers assess for fetal positioning in utero. Placental placement cannot be assessed externally. 2. Although women can have completely concealed bleeding with an abruption, the quantity of blood loss will not differentiate between the two pathologies. 3. The most common difference between placenta previa and placenta abruption is the absence or presence of abdominal pain. 4. Maternal blood pressure is inconclusive. Women with chronic hypertension are at high risk for both problems. TEST-TAKING TIP: Because at least some of the blood from a placental abruption is trapped behind the placenta, women with that complication usually complain of intense, unrelenting pain. But because the blood from a symptomatic placenta previa fl ows freely through the vagina, the bleeding from that complication is virtually pain-free.
A labor nurse is caring for a client, 30 weeks' gestation, who is symptomatic from a complete placenta previa. Which of the following physician orders should the nurse question? 1. Administer betamethasone (Celestone) 12 mg IM daily times 2. 2. Maintain strict bedrest. 3. Assess cervical dilation. 4. Regulate intravenous (Ringer's lactate: drip rate to 150 mL/hr).
3 1. The administration of betamethasone is appropriate. 2. Bedrest is appropriate. 3. An order to assess the woman's cervical dilation should be questioned. 4. An intravenous of Ringer's lactate is appropriate. TEST-TAKING TIP: If the nurse were to assess the cervical dilation of a client with complete previa, he or she could puncture the placenta. Vaginal examinations are absolutely contraindicated with a diagnosis of complete placenta previa. Betamethasone is administered to promote maturation of the baby's lungs.
Following a cesarean birth for abruptio placentae, a multigravid client tells the nurse, "I feel like such a failure. None of my other childbirths were like this." The nurse's response to the client is based on the understanding of which of the following? 1.The client will most likely have postpartum blues. 2.Maternal-infant bonding is likely to be difficult. 3.The client's feeling of grief is a normal reaction. 4.This type of birth was necessary to save the client's life
3 Feelings of loss, grief, and guilt are normal after a cesarean birth, particularly if it was not planned. The nurse should support the client, listen with empathy, and allow the client time to grieve. The likelihood of the client experiencing postpartum blues is not known, and no evidence is presented. Although maternal-infant bonding may be delayed owing to neonatal complications or maternal pain and subsequent medications, it should not be difficult. Although the nurse is aware that this type of birth was necessary to save the client's life, using this as the basis for the response does not acknowledge the mother's feelings.
A nurse is caring for four laboring women. Which of the women will the nurse carefully monitor for signs of abruptio placentae? 1. G2 P0010, 27 weeks' gestation. 2. G3 P1101, 17 years of age. 3. G4 P2101, cancer survivor. 4. G5 P1211, cocaine abuser.
4 1. This client has had one abortion. Although it is not clear whether the abortion was spontaneous or induced, this client is not especially at high risk for placental abruption. 2. This client is an adolescent. She has delivered one full-term baby and one preterm baby. Teens are at high risk for preterm deliveries but are not especially at high risk for placental abruption. 3. Cancer survivors are not especially at high risk for placental abruption. 4. Cocaine is a powerful vasoconstrictive agent. It places pregnant clients at high risk for placental abruptions. TEST-TAKING TIP: It is very important that the test taker not read into any question or response. In the preceding question, all four of the women have had complicated pregnancies. The test taker should not presume the cause of the complications when they are not stated but rather look for the answer that does absolutely place the client at high risk for the abruption.
A 24-year-old client, G 3, P 1, at 32 weeks' gestation, is admitted to the hospital because of vaginal bleeding. After reviewing the client's history, which of the following factors might lead the nurse to suspect abruptio placentae? 1.Several hypotensive episodes. 2.Previous low transverse cesarean birth. 3.One induced abortion. 4.History of cocaine use.
4 Although the exact cause of abruptio placentae is unknown, possible contributing factors include excessive intrauterine pressure caused by hydramnios or multiple pregnancy, cocaine use, cigarette smoking, alcohol ingestion, trauma, increased maternal age and parity, and amniotomy. A history of hypertension is associated with an increased risk of abruptio placentae. A previous low transverse cesarean section and a history of one induced abortion are associated with increased risk of placenta previa, not abruptio placentae
A client presents to the OB triage unit with a report of bright red vaginal bleeding that has saturated a peripad over the last hour. The nurse observes the fetal heart rate with a baseline of 130 decreasing to 100 for 60 seconds and then returning to 130. There are no contractions present. Which are the priority nursing interventions? 1.Ask client time of last oral intake and prepare to start an IV. 2.Continue to observe monitor and perform Leopold's maneuver. 3.Apply oxygen by face mask and perform sterile vaginal exam. 4.Place client in hands and knees position and call primary health care provider.
1 Bright red vaginal bleeding without contractions could indicate a placenta previa. A sterile vaginal exam should never be done on a woman with a known or suspected placenta previa. Because the woman is currently bleeding and the fetal heart rate is showing decelerations, the woman would need fluid replacement and a possible emergent cesarean birth. The woman may also need fluid volume replacement. The nurse can prepare for this by asking last oral intake obtaining IV access. The client should be placed in a lateral position to enhance uteroplacental blood flow and given oxygen. The nurse should notify the primary health care provider as soon as possible, but the hands and knees position is indicated only if the client is experiencing back labor or umbilical cord prolapse. Leopold's maneuver is done to determine fetal position in utero and would have already been done prior to placing the fetal heart rate monitor.
When assessing a 34-year-old multigravid client at 34 weeks' gestation experiencing moderate vaginal bleeding, which of the following would most likely alert the nurse that placenta previa is present? 1.Painless vaginal bleeding. 2.Uterine tetany. 3.Intermittent pain with spotting. 4.Dull lower back pain.
1 The most common assessment finding associated with placenta previa is painless vaginal bleeding. With placenta previa, the placenta is abnormally implanted, covering a portion or all of the cervical os. Uterine tetany, intermittent pain with spotting, and dull lower back pain are not associated with placenta previa. Uterine tetany is associated with oxytocin administration. Intermittent pain with spotting commonly is associated with a spontaneous abortion. Dull lower back pain is commonly associated with poor maternal posture or a urinary tract infection with renal involvement.
The primary health care provider prescribes whole blood replacement for a multigravid client with abruptio placentae. Before administering the intravenous blood product, the nurse should first: 1.Validate client information and the blood product with another nurse. 2.Check the vital signs before transfusing over 5 to 6 hours. 3.Ask the client if she has ever had any allergies. 4.Administer 100 mL of 5% dextrose solution intravenously
1 When administering blood replacement therapy, extreme caution is needed. Before administering any blood product, the nurse should validate the client information and the blood product with another nurse to prevent administration of the wrong blood transfusion. Although baseline vital signs are necessary, she should initiate the infusion of blood slowly for the first 10 to 15 minutes. Then, if there is no evidence of a reaction, she should adjust the rate of infusion to ensure that the blood product is infused over 2 to 4 hours. The nurse can ask the client if she has ever had a reaction to a blood product, but a general question about allergies may not elicit the most complete response about any reactions to blood product administration. Blood transfusions are typically given with intravenous normal saline solution, not dextrose solutions.
A delirious patient is admitted to the hospital in labor. She has had no prenatal care and vials of crack cocaine are found in her pockets. The nurse monitors this client carefully for which of the following intrapartal complications? 1. Prolonged labor. 2. Prolapsed cord. 3. Abruptio placentae. 4. Retained placenta.
3 1. Prolonged labor is not associated with maternal illicit drug use. 2. Prolapsed cord is not associated with maternal illicit drug use. 3. Placental abruption is associated with maternal illicit drug use. 4. Retained placenta is not associated with maternal illicit drug use. TEST-TAKING TIP: Crack cocaine is a powerful vasoconstrictive agent. The chorionic villi atrophy as a result of the vasoconstrictive effects of the drug. Placental abruption, when the placenta detaches from the decidual lining of the uterus, is therefore of particular concern.
A gravid woman has just been admitted to the emergency department subsequent to a head-on automobile accident. Her body appears to be uninjured. The nurse carefully monitors the woman for which of the following complications of pregnancy? Select all that apply. 1. Placenta previa. 2. Transverse fetal lie. 3. Placental abruption. 4. Severe pre-eclampsia. 5. Preterm labor.
3,5 1. Placenta previa is not an acute problem. It is related to the site of placental implantation. 2. Transverse fetal lie is a malpresentation. It would not be related to the auto accident. 3. Placental abruption may develop as a result of the auto accident. 4. Pre-eclampsia does not occur as a result of an auto accident. 5. The woman may go into preterm labor after an auto accident. TEST-TAKING TIP: The fetus is well protected within the uterine body. The musculature of the uterus and the amniotic fluid provide the baby with enough cushioning to withstand minor bumps and falls. A major automobile accident, however, can cause anything from preterm premature rupture of the membranes, to preterm labor, to a ruptured uterus, to placental abruption. The nurse should especially monitor the fetal heartbeat for any variations.
During admission, a multigravida in early active labor acts somewhat euphoric and tells the nurse that she smoked some crack cocaine before coming to the hospital. In addition to fetal heart rate assessment, the nurse should monitor the client for symptoms of which of the following? 1.Placenta previa. 2.Ruptured uterus. 3.Maternal hypotension. 4.Abruptio placentae.
4 Dramatic vasoconstriction occurs as a result of sniffing crack cocaine. This can lead to increased respiratory and cardiac rates and hypertension. It can severely compromise placental circulation, resulting in abruptio placentae and preterm labor and birth. Infants of these women can experience intracranial hemorrhage and withdrawal symptoms of tremulousness, irritability, and rigidity. Placenta previa, ruptured uterus, and maternal hypotension are not associated with cocaine use. Placenta previa may be associated with grand multiparity. Ruptured uterus may be associated with a large-for-gestational-age fetus.
A labor nurse is caring for a client, 38 weeks' gestation, who has been diagnosed with symptomatic placenta previa. Which of the following orders by the primary healthcare provider should the nurse question? 1. Begin oxytocin drip rate at 0.5 milliunit/min. 2. Assess fetal heart rate every 10 minutes. 3. Weigh all vaginal pads. 4. Assess hematocrit and hemoglobin.
1 1. An order for oxytocin administration should be questioned. 2. The fetal heart should be assessed regularly. 3. Weighing the vaginal pads is appropriate at this time. 4. Assessing the hemoglobin and hematocrit is appropriate at this time. TEST-TAKING TIP: Because the stem states that this woman has symptomatic placenta previa, the test taker can conclude that the woman is bleeding vaginally. It would be appropriate to monitor the fetal heart for any signs of distress, to weigh pads to determine the amount of blood loss, and to assess the hematocrit and hemoglobin to check for anemia. Labor, however, is contraindicated, because vaginal delivery is contraindicated.
The nurse should do which of the following actions first when admitting a multigravid client at 36 weeks' gestation with a probable diagnosis of abruptio placentae? 1.Prepare the client for a vaginal examination. 2.Obtain a brief history from the client. 3.Insert a large-gauge intravenous catheter. 4.Prepare the client for an ultrasound scan.
3 Abruptio placentae is a medical emergency because the degree of hypovolemic shock may be out of proportion to visible blood loss. On admission, the nurse should plan to first insert a large-gauge intravenous catheter for fluid replacement and oxygen by mask to decrease fetal anoxia. Vaginal examination usually is not performed on pregnant clients who are experiencing third-trimester bleeding due to abruptio placentae because it can result in damage to the placenta and further fetal anoxia. The client's history can be obtained once the client has been admitted and the intravenous line has been started. The goal is birth of the fetus, usually by emergency cesarean section. The nurse should also plan to monitor the client's vital signs and the fetal heart rate. Ultrasound is of limited use in the diagnosis of abruptio placentae.
