Maternity Nursing Q 176

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Which of the following would the nurse assess in a client experiencing abruptio placenta?

  

     A. Bright red, painless vaginal bleeding

     B. Concealed or external dark red bleeding

     C. Palpable fetal outline

     D. Soft and nontender abdomen

    

    

Correct Answer: B. Concealed or external dark red bleeding

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A client with abruptio placentae may exhibit concealed or dark red bleeding, possibly reporting sudden intense localized uterine pain. The uterus is typically firm to board-like, and the fetal presenting part may be engaged.

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Option A: Painless vaginal bleeding during the second or third trimester of pregnancy is the usual presentation in placenta previa. The bleeding may be provoked from intercourse, vaginal examinations, labor, and at times there may be no identifiable cause. On speculum examination, there may be minimal bleeding to active bleeding.

Option C: On physical examination, the uterus tends to be soft and fetal parts are readily palpable. With placenta previa, the presenting part is unengaged and malpresentation is common, seen in up to 50% of cases.

Option D: Abdominal examination usually finds the uterus non-tender, soft and relaxed. Leopold’s Maneuvers may find the fetus in an oblique or breech position or lying transverse as a result of the abnormal position of the placenta. Malpresentation is found in about 35% cases.

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