1. A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which

ofthe following findings support this diagnosis?

A. Painless red vaginal bleeding

Rationale: Placenta previa is a condition of pregnancy when the placenta implants in the lower part of the

uterus, partly or completely obstructing the cervical os (outlet to the vagina). Bright red, painless

vaginal bleeding occurs in the second and third trimester.

B. Increasing abdominal pain with a nonrelaxed uterus

Rationale: Abruptio placenta is separation of the placenta from the site of uterine implantation before

delivery of the fetus. When the placenta separates prematurely, there is internal bleeding, which

is painful, and the uterus is nonrelaxed or becomes rigid as the separation advances.

C. Abdominal pain with scant red vaginal bleeding

Rationale: Placenta previa involves minimal to severe bright red vaginal bleeding in the absence of

abdominal pain.

D. Intermittent abdominal pain following passage of bloody mucus

Rationale: Intermittent abdominal pain following passage of bloody mucus is a description of normal labor.

The passage of bloody mucus represents the loss of the cervical mucous plug, also referred to

as the "bloody show."

2. A nurse is caring for a client who is 1 hr postpartum and observes a large amount of lochia rubra and several

smallclots on the client's perineal pad. The fundus is midline and firm at the umbilicus. Which of the following

actions should the nurse take?

A. Document the findings and continue to monitor the client.

Rationale: These are expected findings. At 1 hr postpartum, lochia rubra should be intermittent and

associated with uterine contractions. The volume of lochia resembles that of a heavy menstrual

period. Small clots are common. The nurse should document the findings and continue to

monitor the client.

B. Notify the client’s provider.

Rationale: These are expected findings, so there is no need to notify the provider.

C. Increase the frequency of fundal massage.

Rationale:These are expected findings and the fundus is already firm. Increasing the frequency of fundal

massage is not indicated at this time.

D. Encourage the client to empty her bladder.

Rationale: These are expected findings, and the fundus is firm at the midline. If the fundus was deviated,

this would be an indication of a distended bladder and the client should be encouraged to void to

prevent uterine atony.