A healthcare provider in the emergency department is caring for a client who comes to the emergency department reporting severe abdominal pain in the left lower quadrant. The provider suspects a ruptured ectopic pregnancy. Which of the following signs indicates to the provider the presence of intra-abdominal bleeding?

Correct Answer: B

Rationale: Cullen's sign is the presence of periumbilical ecchymosis indicating intra-abdominal bleeding, which can be associated with a ruptured ectopic pregnancy. Chvostek's sign is a facial spasm related to hypocalcemia. Chadwick's sign is a bluish discoloration of the cervix, vagina, and labia during early pregnancy. Goodell's sign is a softening of the cervix in early pregnancy.

Correct Answer: C

Rationale: In a pregnant woman with a temperature of 38.9°C (102°F) in early labor with ruptured membranes, assessing the odor of the amniotic fluid is crucial. Foul-smelling or malodorous amniotic fluid could indicate infection, such as chorioamnionitis, which poses risks to both the woman and the fetus. This assessment can help in determining if an infection is present and prompt appropriate interventions. Rechecking the temperature, administering glucocorticoids, or preparing for an emergency cesarean section are not the most immediate or appropriate actions in this scenario.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Abruptio placentae. Abruptio placentae is a condition where the placenta partially or completely peels away from the uterine wall before delivery. This can cause severe abdominal pain and vaginal bleeding, which are symptoms the client is experiencing. Let's discuss why the other options are incorrect: A) Placenta previa involves the placenta partially or fully covering the cervix, usually presenting with painless vaginal bleeding. This is not consistent with the client's symptoms of abdominal pain. B) Prolapsed cord is when the umbilical cord descends through the cervix ahead of the baby, which can lead to fetal distress but does not typically cause maternal abdominal pain. C) Incompetent cervix is characterized by painless cervical dilation in the second trimester, not typically causing sudden abdominal pain and bleeding in the third trimester. Educationally, understanding these differential diagnoses is crucial for nurses caring for pregnant clients. Recognizing the signs and symptoms of complications like abruptio placentae is vital for timely intervention, which can significantly impact maternal and fetal outcomes. This case emphasizes the importance of thorough assessment and critical thinking in maternal care to provide safe and effective nursing interventions.

Correct Answer: D

Rationale: In the scenario described, the client is experiencing heavy vaginal bleeding, which is concerning for placenta previa. The appropriate nursing action in this situation is to prepare for a cesarean birth. Placenta previa is a condition where the placenta partially or completely covers the cervix, which can lead to life-threatening bleeding during labor. It is crucial to avoid vaginal examinations or initiation of pushing as these actions can exacerbate bleeding. A magnesium sulfate infusion is not indicated in the management of placenta previa. Therefore, the priority intervention is to prepare for a cesarean birth to ensure the safety of the mother and the baby.

Correct Answer: C

Rationale: Polyhydramnios refers to the presence of an excessive amount of amniotic fluid around the fetus. This condition can result from various causes, such as maternal diabetes, fetal anomalies, or genetic disorders. It can lead to complications during pregnancy and delivery, such as preterm labor, placental abruption, or fetal malpresentation. Understanding this diagnosis is crucial for providing appropriate care and monitoring to ensure the best outcomes for both the mother and the fetus.