Page 723 - Saunders Comprehensive Review For NCLEX-RN

blood behind the placenta. The abdomen feels hard and board-like on palpation as
the blood penetrates the myometrium and causes uterine irritability. A soft abdomen
and painless, bright red vaginal bleeding in the second or third trimester of
pregnancy are signs of placenta previa.
Test-Taking Strategy: Focus on the subject, assessment findings in abruptio
placentae. Remember that the difference between placenta previa and abruptio
placentae involves the presence of uterine pain and tenderness with abruptio
placentae, as opposed to painless bleeding with placenta previa.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Maternity: Intrapartum
Health Problem: Maternity: Abruptio placentae
Priority Concepts: Clinical Judgment; Perfusion
Reference: McKinney et al. (2018), pp. 531-532.

220. Answer: 2

Rationale: Placenta previa is an improperly implanted placenta in the lower
uterine segment near or over the internal cervical os. Manual pelvic examinations are
contraindicated when vaginal bleeding is apparent until a diagnosis is made and
placenta previa is ruled out. Digital examination of the cervix can lead to
hemorrhage. A diagnosis of placenta previa is made by ultrasound. The hemoglobin
and hematocrit levels are monitored, and external electronic fetal heart rate
monitoring is initiated. Electronic fetal monitoring (external) is crucial in evaluating
the status of the fetus, who is at risk for severe hypoxia.
Test-Taking Strategy: Focus on the subject, nursing care of the client with
placenta previa. Use knowledge of the pathophysiology associated with placenta
previa. Note the words question which prescription in the event query. Also, note that
the correct option is the only procedure that is invasive to the pregnancy and
endangers the physiological safety of the client and the fetus.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Maternity: Intrapartum
Health Problem: Maternity: Placenta previa
Priority Concepts: Collaboration; Safety
Reference: McKinney et al. (2018), pp. 529-530.

221. Answer: 1

Rationale: Abruptio placentae is the premature separation of the placenta from
the uterine wall after the 20th week of gestation and before the fetus is delivered.
The goal of management in abruptio placentae is to control the hemorrhage and
deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is
at term gestation or if the bleeding is moderate to severe and the client or fetus is in
jeopardy. Because delivery of the fetus is necessary, options 2, 3, and 4 are incorrect

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