A woman in the emergency department is in her third trimester and is bleeding heavily from a laceration on her thigh from a car crash. She is pale and diaphoretic. Her blood pressure is 138/82 mm Hg. What can the nurse conclude from this information?
A.
Blood loss from the laceration has not been that great.
B.
She is in shock from the trauma of the injury and blood loss.
C.
Her increased blood volume is maintaining the blood pressure.
D.
Her vital signs and physical assessment do not match.
ANS: C
Maternal blood volume increases by 40 to 50% near term. The nurse would expect the blood pressure to be low due to the blood loss, but the pregnancy-related extra volume is maintaining the blood pressure at normal levels. The vital signs and physical assessment do not match, but that is vague and does not explain the inconsistency. The patient is not in shock.
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