Which pregnant woman would the nurse suspect of having placenta ...

[Ebrown]

Which pregnant woman would the nurse suspect of having placenta previa?
 
  a. A gravida 3, para 2 in her twenty-eighth week of gestation who reports painless vaginal bleeding and whose blood pressure is 116/78 mm Hg
  b. A gravida 1, para 0 in the twentieth week of gestation with vomiting, white vaginal discharge, and blood pressure of 170/94 mm Hg
  c. A gravida 5, para 4 in the thirtieth week of gestation with severe abdominal pain, dark red vaginal bleeding, and blood pressure of 110/64 mm Hg
  d. A gravida 1, para 0 in the twelfth week of gestation with abdominal and shoulder pain, no bleeding, and blood pressure of 100/54 mm Hg

Question 2

The nurse recognizes that digital vaginal examinations are contraindicated in pregnant women who are bleeding because:
 
  a. There is a high risk of infection because of the open cervical os.
  b. The examination may stimulate the onset of labor prematurely.
  c. The presence of blood will make palpation difficult.
  d. The examination may cause severe hemorrhage.

[HandsomeMarc]

Answer to Question 1

ANS: A
Placenta previa is most common after 24 weeks' gestation and is characterized by painless vaginal bleeding. A patient who is gravida 1, para 0 in the twentieth week of gestation with vomiting, white vaginal discharge, and blood pressure of 170/94 mm Hg is hypertensive and may have hyperemesis gravidarum and a vaginal infection. A gravida 5, para 4 in the thirtieth week of gestation with severe abdominal pain, dark red vaginal bleeding, and blood pressure of 110/64 mm Hg has symptoms suggestive of abruptio placenta. A gravida 1, para 0 in the twelfth week of gestation with abdominal and shoulder pain, no bleeding, and blood pressure of 100/54 mm Hg has symptoms of an ectopic pregnancy.

Answer to Question 2

ANS: D
The risk of inducing hemorrhage contraindicates digital vaginal examinations in the pregnant woman who is bleeding until the source of the bleeding is identified.