Practice Question
A nurse is caring for a client who is at 34 weeks of gestation.
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Rationale:
Hematocrit level – Consistent with Both Placenta Previa and Abruptio Placenta
❖ A hematocrit of 30% (below the normal threshold of 33% in pregnancy) indicates maternal blood loss.
❖ In placenta previa, blood loss is typically external and visible, causing gradual reductions in hematocrit.
❖ In abruptio placentae, bleeding can be concealed or external, and significant internal bleeding can lower hematocrit quickly.
❖ Therefore, a decreased hematocrit can reflect hemorrhagic complications in both conditions.
❖ It is important to monitor for signs of hypovolemia and initiate fluid replacement promptly in either case.
Client's Pain Level – Consistent with Placenta Previa
❖ The client reports no abdominal pain, which is classic for placenta previa.
❖ Placenta previa typically causes painless, bright red vaginal bleeding due to the placenta being located near or over the cervical os.
❖ In contrast, abruptio placentae often presents with sudden, severe abdominal pain due to premature placental separation.
❖ Absence of pain in this client makes placenta previa more likely than abruption.
❖ Pain assessment helps differentiate the underlying cause of bleeding during the third trimester.
Fundal Height – Consistent with Both Placenta Previa and Abruptio Placenta
❖ The fundal height is 37 cm at 34 weeks gestation, which is larger than expected.
❖ An increased fundal height can result from concealed bleeding (seen in abruptio placentae), or placental abnormalities (such as previa).
❖ In abruption, blood accumulates behind the placenta and may cause uterine distention, increasing fundal height.
❖ In previa, repeated bleeding episodes may also cause uterine enlargement or contribute to polyhydramnios, raising fundal height.
❖ Therefore, this finding is non-specific and can occur in both conditions.
Uterine Tone – Consistent with Placenta Previa
❖ The uterus is described as soft and nontender, which is indicative of placenta previa.
❖ In placenta previa, there is no placental separation, so the uterus does not become irritable or firm.
❖ In contrast, abruptio placentae typically presents with a firm, rigid, and tender uterus due to the accumulation of blood in the uterine wall.
❖ Uterine tone is a critical clinical indicator to differentiate between these conditions.
❖ A soft uterus without pain makes abruption less likely in this client.
Description of Vaginal Bleeding – Consistent with Placenta Previa
❖ The client is experiencing bright red vaginal bleeding, which is classic for placenta previa.
❖ In placenta previa, bleeding originates from the placental site near the cervix, leading to fresh, bright red blood.
❖ This bleeding is often painless and recurrent during the third trimester.
❖ In abruptio placentae, bleeding is usually dark red and often accompanied by pain and uterine tenderness.
❖ Therefore, this bleeding pattern strongly supports a diagnosis of placenta previa.
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This question is from Custom: NUR 2463 Exam #2 which contains 20 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN Custom Exam(s)
- Answer Choices: 0