Page 724 - Saunders Comprehensive Review For NCLEX-RN

regarding management of a client with abruptio placentae.
Test-Taking Strategy: Focus on the subject, management of abruptio placentae.
Use knowledge regarding the pathophysiology and management of abruptio
placentae to answer the question. Note the words term gestation and moderate vaginal
bleeding. Knowing that the goal is to deliver the fetus will direct you easily to the
correct option.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Planning
Content Area: Complex Care: Emergency Situations/Management
Health Problem: Maternity: Abruptio placentae
Priority Concepts: Perfusion; Safety
Reference: Lowdermilk et al. (2016), p. 684.

222. Answer: 2

Rationale: In placenta previa, the placenta is implanted in the lower uterine
segment. The lower uterine segment does not contain the same intertwining
musculature as the fundus of the uterus, and this site is more prone to bleeding.
Options 1, 3, and 4 are not risks that are related specifically to placenta previa.
Test-Taking Strategy: Focus on the subject, the risks associated with placenta
previa. Thinking about the pathophysiology associated with this disorder and
recalling that bleeding is a primary concern in this client will direct you easily to the
correct option.
Level of Cognitive Ability: Analyzing
Client Needs: Physiological Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Maternity: Postpartum
Health Problem: Maternity: Placenta previa
Priority Concepts: Clinical Judgment; Perfusion
Reference: Lowdermilk et al. (2016), p. 682.

223. Answer: 4, 5, 6

Rationale: Placenta previa is an improperly implanted placenta in the lower
uterine segment near or over the internal cervical os. Painless, bright red vaginal
bleeding in the second or third trimester of pregnancy is a sign of placenta previa.
The client has a soft, relaxed, nontender uterus, and fundal height may be more than
expected for gestational age. In abruptio placentae, severe abdominal pain is present.
Uterine tenderness accompanies placental abruption. In addition, in abruptio
placentae, the abdomen feels hard and board-like on palpation, as the blood
penetrates the myometrium and causes uterine irritability.
Test-Taking Strategy: First, eliminate options 1 and 2 because they are
comparable or alike. Next, 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 bright red bleeding with placenta previa.
Level of Cognitive Ability: Analyzing

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