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Client at 38 weeks of gestation experiencing continuous abdominal pain and vaginal bleeding, with a history of cocaine use.
A nurse is caring for a client who is at 38 weeks of gestation and is experiencing continuous abdominal pain and vaginal bleeding. The client has a history of cocaine use. The nurse should identify that the client is likely experiencing which of the following complications?
- A. Abruptio placentae.
- B. Hydatidiform mole.
- C. Preterm labor.
- D. Placenta previa.
Correct Answer: A
Rationale: Abruptio placentae involves premature placental separation, linked to cocaine use, which increases vasoconstriction and hypertension. Symptoms include pain, vaginal bleeding, and fetal distress due to impaired placental function.
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Client in labor with an intrauterine pressure catheter and an internal fetal scalp electrode for monitoring, receiving oxytocin.
A nurse is caring for a client who is receiving oxytocin to augment labor. The client has an intrauterine pressure catheter and an internal fetal scalp electrode for monitoring. Which of the following is an indication that the nurse should discontinue the infusion?
- A. Contraction frequency every 3 minutes.
- B. Contraction duration of 100 seconds.
- C. Fetal heart rate of 118/min.
- D. Fetal heart rate with moderate variability.
Correct Answer: B
Rationale: Contraction duration of 100 seconds exceeds the normal range (usually less than 90 seconds), risking uterine hyperstimulation and fetal compromise, necessitating oxytocin discontinuation.
Client reporting severe abdominal pain.
A nurse in the labor and delivery triage unit reviews the electronic medical record (EMR) of a client reporting severe abdominal pain. Which of the following findings is most consistent with abruptio placenta?
- A. Low uterine tone with mild vaginal bleeding.
- B. Rigid uterine tone with dark vaginal bleeding.
- C. Soft uterine tone with painless vaginal bleeding.
- D. Low uterine tone with absence of vaginal bleeding.
Correct Answer: B
Rationale: Rigid uterine tone with dark vaginal bleeding is a hallmark of abruptio placenta. The rigidity arises from blood pooling behind the placenta, causing uterine muscle contraction. Dark vaginal bleeding occurs as the blood is often concealed and clotted before expulsion.
Client experiencing preterm labor with a new prescription for terbutaline.
A nurse is caring for a client who is experiencing preterm labor and has a new prescription for terbutaline. Which of the following findings is a contraindication for administration of this medication?
- A. Heart disease.
- B. Cervical dilation of 2 cm.
- C. Gestational age of 34 weeks.
- D. Allergy to penicillin.
Correct Answer: A
Rationale: Terbutaline is contraindicated in heart disease because it can cause tachycardia and arrhythmias, worsening cardiac conditions. Cardiovascular side effects result from its beta-adrenergic agonist action.
Client at 31 weeks of gestation receiving magnesium sulfate via continuous IV infusion for preterm labor.
A nurse is assessing a client who is at 31 weeks of gestation and is receiving magnesium sulfate via continuous IV infusion for preterm labor. Which of the following findings should the nurse report to the provider?
- A. Respiratory rate 11/min.
- B. Deep tendon reflexes 2+.
- C. Urine output 30 mL/hr.
- D. Blood pressure 100/62 mm Hg.
Correct Answer: A
Rationale: A respiratory rate of 11/min is below the normal adult range of 12–20/min and indicates respiratory depression, a potential adverse effect of magnesium sulfate requiring immediate intervention.
Client at 34 weeks of gestation scheduled for a nonstress test.
A nurse is providing teaching to a client who is at 34 weeks of gestation and is scheduled for a nonstress test. Which of the following statements should the nurse plan to make?
- A. You will receive a medication through an IV for this test.
- B. You should expect the test to take about 30 minutes.
- C. You should not eat or drink for 4 hours prior to the test.
- D. This test will help determine if your baby's lungs are mature.
Correct Answer: B
Rationale: Nonstress tests typically last about 20–40 minutes, depending on fetal activity and reactivity. This duration allows sufficient time to observe fetal heart rate accelerations.