Editing Maternal and Newborn Nursing – RN Practice Questions (section)

==Question 8==
A client at 32 weeks' gestation with chronic hypertension reports sudden constant abdominal pain. Which findings support a diagnosis of placental abruption? '''Select all that apply.'''
# A rigid, board-like, tender uterus
# Painless bright red vaginal bleeding
# Dark red vaginal bleeding, possibly minimal relative to symptoms
# Category III fetal heart rate tracing
# A fundal height that increases over serial measurements
# A soft, nontender, relaxed uterus between contractions

'''Answer:''' 1, 3, 4, 5 (A, C, D, E).

''Rationale:'' Abruption is premature separation of a normally implanted placenta. Blood dissects into the myometrium, producing a rigid, exquisitely tender uterus, dark bleeding, and often a nonreassuring or Category III tracing from loss of placental surface area. Bleeding can be '''concealed''' behind the placenta, so an enlarging uterus or rising fundal height signals ongoing blood loss even when external bleeding looks trivial; never estimate abruption severity from visible blood alone. Options 2 and 6 describe placenta previa, in which bleeding is painless and bright red and the uterus stays soft. Watch for DIC and hypovolemic shock, and remember that no vaginal examination is performed when previa has not been ruled out.