A nurse has admitted a woman pregnant in her third trimester with moderate vaginal bleeding and severe abdominal pain. After assessing maternal vital signs, obtaining the fetal heart rate, and starting an IV line, which action should the nurse do next?
A.
Administer betamethasone (Celestone) just prior to delivery.
B.
Discuss pros and cons of continuous fetal monitoring.
C.
Facilitate laboratory work, including blood type and screen.
D.
Obtain informed consent for emergent delivery.
ANS: C
Women who present with third-trimester vaginal bleeding should be examined carefully for placenta previa or abruptio placentae. Bleeding accompanied by abdominal pain is the classic sign of placental abruption. Care includes obtaining maternal vital signs, assessing fetal heart rate, and starting an IV for fluid resuscitation or transfusion if needed. Blood work should be obtained for CBC, type and screen, coagulation studies, and a Kleihauer Betke determination, Betamethasone is given if delivery is not imminent. Continuous electronic fetal monitoring is the standard of care, and although the nurse should educate the patient on its use, this discussion does not take priority over obtaining diagnostic laboratory studies. An emergent delivery is a possible (not certain) outcome, but obtaining consent does not take priority over the diagnostic blood work.
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