Maternity Nursing Q 20

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Which of the following would the nurse most likely expect to find when assessing a pregnant client with abruption placenta?

  

     A. Excessive vaginal bleeding

     B. Rigid, board-like abdomen

     C. Tetanic uterine contractions

     D. Premature rupture of membranes

    

    

Correct Answer: B. Rigid, board-like abdomen

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The most common assessment finding in a client with abruption placenta is a rigid or boardlike abdomen. Pain, usually reported as a sharp stabbing sensation high in the uterine fundus with the initial separation, also is common.

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Option A: It’s possible for the blood to become trapped inside the uterus, so even with a severe placental abruption, there might be no visible bleeding.

Option C: Uterine contractions are a common finding with placental abruption. Contractions progress as the abruption expands, and uterine hypertonus may be noted. Contractions are painful and palpable.

Option D: Increased frequency of placental abruption was found in patients with early rupture of membranes. The incidence was 50% and 44% when rupture of the membranes occurred before 20 weeks or between 20-24 weeks of pregnancy, respectively.

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