(Part 1) Placenta Previa
(PENALTY: -50 points)
A 32-year-old pregnant woman, KC, is at 30 weeks gestation and arrives at the emergency department with painless, bright red vaginal bleeding. Which of the following interventions should the nurse prioritize?
A. Perform a vaginal examination to assess cervical dilation.
B. Place the patient in a left lateral position and prepare for an ultrasound.
C. Encourage the patient to ambulate to relieve pressure.
D. Administer oxytocin to control the bleeding.
Answer: B
Rationale: In placenta previa, a vaginal examination is contraindicated due to the risk of severe hemorrhage. The left lateral position improves blood flow, and ultrasound confirms the diagnosis.
(PENALTY: -70)
Which of the following is not a characteristic of placenta previa?
- A. Painless, bright red vaginal bleeding
- B. Fetal distress due to compromised oxygen supply
- C. Soft, non-tender uterus
- D. Bleeding that often occurs after 20 weeks of gestation
Answer: B
Rationale: Placenta previa usually does not cause fetal distress unless there is massive hemorrhage. The uterus remains soft and non-tender.
It is the premature separation of the placenta from the uterine lining before the delivery of the fetus?
Ans: Abruptio Placenta
Rationale:
Abruptio Placenta is the premature separation of the placenta from the uterine lining before delivery, leading to vaginal bleeding, abdominal pain, and potential fetal distress. It is a serious obstetric complication that can endanger both the mother and baby.
A patient with abruptio placenta is likely to experience which symptom?
a) Painless vaginal bleeding
b) Soft, relaxed uterus
c) Rigid, tender uterus
d) Increased fetal movement
Answer: c) Rigid, tender uterus
Rationale: This is due to the inflammation and irritation of the
uterine wall from the accumulated blood in the uterus.
This is a type of H-mole wherein the ovum contains no genetic material, and during fertilization, the entire genetic material will be paternal (from the sperm)
Complete Hydatidiform Mole
R: A Complete Hydatidiform Mole occurs when an empty ovum (lacking genetic material) is fertilized by a sperm, which then duplicates its genetic material, resulting in a 46,XX or 46,XY karyotype entirely of paternal origin. This leads to no fetal development and excessive trophoblastic proliferation, causing extremely high beta-hCG levels and a snowstorm pattern on ultrasound.
(PENALTY: -90 points)
Max, a 24-year-old patient diagnosed with placenta previa, received health teaching. The nurse said that Max should avoid sexual intercourse with her partner for 2 weeks after the diagnosis. Is this true or false?
Answer: False
Rationale: Sexual activity may trigger bleeding due to cervical irritation, increasing the risk of hemorrhage. Therefore, abstinence from coitus, in the case of placenta previa, should be maintained for the entire duration of the pregnancy.
(PENALTY: -100 points)
A patient with marginal placenta previa can deliver through NSVD. True or False?
Answer: True
Rationale: Unless there is an evident hemorrhage already that will require an emergency cesarean section, the first choice will always be NSVD especially that marginal placenta previa can still be resolved on its own as the pregnancy progresses and the uterus expands to accommodate the product of conception.
What is the most critical nursing intervention for a patient with severe Abruptio Placenta?
a) Encourage bed rest and oral hydration
b) Monitor fetal heart rate and maternal vital signs closely
c) Perform frequent vaginal exams
d) Delay delivery to allow fetal lung maturity
Answer: b) Monitor fetal heart rate and maternal vital signs closely
Rationale: Early detection of fetal distress or maternal shock is crucial for preventing complications.
In cases of severe hemorrhage due to Abruptio Placenta, what is the immediate medical management?
a) Induction of labor
b) Emergency cesarean section
c) Administration of tocolytics
d) Monitoring for spontaneous resolution
Answer: b) Emergency cesarean section
Rationale: If fetal distress is present or maternal bleeding is severe, immediate delivery is required to prevent life-threatening complications.
A patient with a history of a recently evacuated hydatidiform mole has persistently elevated beta-hCG levels. What is the nurse’s priority action?
A. Reassure the patient that hCG levels take months to normalize
B. Monitor for signs of choriocarcinoma and notify the physician
C. Advise the patient to try conceiving to regulate hormone levels
D. Encourage the patient to stop contraceptive use for better hormonal balance
Answer:
B. Monitor for signs of choriocarcinoma and notify the physician
Rationale:
Persistently elevated beta-hCG levels after a molar pregnancy evacuation may indicate gestational trophoblastic neoplasia (GTN), including choriocarcinoma, which requires prompt medical intervention. The nurse should monitor for metastasis, reinforce the need for hCG follow-up testing, and coordinate with the physician for further evaluation and possible chemotherapy.
(PENALTY: -150 points)
What diagnostic test is commonly used to confirm placenta previa?
Answer: Ultrasound
Rationale: Transabdominal ultrasound is the safest and most accurate way to diagnose placenta previa.
(PENALTY: REGRET!)
What is the primary symptom of placenta previa?
Answer: Painless vaginal bleeding
Rationale: The hallmark symptom is sudden, bright red bleeding that is painless, differentiating it from placental abruption.
Which of the following describes a Class 3 (Severe) case of Abruptio Placenta?
a) No vaginal bleeding, normal maternal vitals, no fetal distress
b) Moderate bleeding, mild uterine tenderness, maternal tachycardia
c) Heavy bleeding, uterine rigidity, maternal shock, fetal death
d) No bleeding, slight uterine tenderness, no fetal distress
Answer: c) Heavy bleeding, uterine rigidity, maternal shock, fetal death
Rationale: In Class 3 cases, severe placental detachment leads to major blood loss, maternal shock, and fetal death if untreated.
Which physiological function is impaired due to placental abruption?
a) Nutrient and oxygen exchange between mother and fetus
b) Amniotic fluid production
c) Fetal immune system development
d) Increased fetal urine output
Answer: a) Nutrient and oxygen exchange between mother and fetus
Rationale: The placenta is responsible for oxygen and nutrient delivery to the fetus. Abruption disrupts this function, causing fetal distress.
A patient just underwent a D&C for ver H-mole, how long shall the patient avoid pregnancy and why?
A: 6 months because the patient would continuously monitor their bhCG levels for 6 months, this is to track any complications post-evacuation and treatment effectivity. However, pregnancy would make bhCG tracking difficult because it would alter bhCG levels.
(PENALTY: -230 points)
Give two interventions that should be avoided in placenta previa.
Answer:
- Digital or internal vaginal examination
- Use of oxytocin for labor induction
Rationale: Internal exams can cause hemorrhage, and labor induction can lead to placental detachment and fetal distress.
(PENALTY: -200 points)
What medication is commonly given to help mature the fetal lungs in a preterm pregnancy complicated by placenta previa?
Answer: Betamethasone/Corticosteroids
Rationale: Corticosteroids like betamethasone are administered to enhance fetal lung maturity when preterm birth is anticipated due to complications like placenta previa.
Which of the following is a potential surgical management option for severe cases of abruptio placenta with life-threatening hemorrhage?
a) Dilation and curettage (D&C)
b) Hysterectomy
c) Episiotomy
d) Tubal ligation
Answer: b) Hysterectomy
Rationale: In severe cases where bleeding cannot be controlled, a hysterectomy (removal of the uterus) may be necessary to save the mother’s life.
Which nursing intervention is contraindicated in a patient with suspected abruptio placenta?
a) Continuous fetal monitoring
b) Administering oxygen as ordered
c) Performing a vaginal examination
d) Preparing for possible emergency delivery
Answer: c) Performing a vaginal examination
Rationale: Vaginal exams are avoided in suspected placental abruption because they
What is the drug of choice for treating hydatidiform mole if malignant transformation occurs, specifically, gestational trophoblastic neoplasia?
A: Methotrexate as first line, Dactinomycin as alternative.
R: While suction curettage is the primary treatment for hydatidiform mole, methotrexate is the drug of choice if gestational trophoblastic neoplasia (GTN) develops. It works by inhibiting trophoblastic cell proliferation. Actinomycin D is used as an alternative if methotrexate is contraindicated.
(PENALTY: -350 points)
Kyline, a 27-year-old G2P0 mother, underwent a dilation and curettage (D&C) following an incomplete abortion during her first pregnancy. Now, in her second pregnancy, she discovered that her placenta is implanted just 2 inches from her cervix. Based on the pathophysiology of placenta previa, why might there be an abnormal placental placement following an invasive procedure like a D&C?
Answer with rationale: After an invasive procedure like a D&C, damage to the uterine wall can occur, leading to a reduction in blood supply to certain areas of the uterus. As a result, the placenta may implant in a region of the uterine wall that has better blood supply, which is often closer to the cervix, leading to the development of placenta previa.
(PENALTY: -300 points)
List three risk factors for placenta previa.
Answers:
- Previous cesarean section
- Multiple pregnancies (twins, triplets)
- Advanced maternal age (>35 years)
Rationale: Scarring from previous surgeries, increased placental surface area, and maternal age all contribute to the risk.
These are a group of drugs given to the patient inorder to slow or even inhibit labor. This is to prevent premature labor or contractions.
Answer: Tocolytics
R: Tocolytics such as Magnesium Sulfate and Terbutaline are used to prevent premature birth in the case of abruptio placenta.
What is the difference between revealed and concealed abruption placenta?
Answer w/ R: Revealed; bleeding tracks down from the site of placental separation and drains through the cervix. This results in vaginal bleeding. Concealed; Bleeding remains within uterus and typically forms a clot retroplacental- bleeding is not visible but can be severe enough to cause systemic shock.
A nurse is reviewing the laboratory results for a patient with an early detected hydatidiform mole. What finding is most expected?
A. High Progesterone, Low estrogen
B. Low progesterone, High Estrogen
C. High Progesterone, High Estrogen
D.Low Progesterone, Low Estrogen
A: A. High Progesterone, Low Estrogen
R: In early hydatidiform mole, high beta-hCG overstimulates the corpus luteum, leading to high progesterone, while estrogen remains low due to the absence of a functional placenta.