Question

Heidi is a 16 year old gravida 2/0 at 35 weeks who arrives by ambulance. Emergency personnel report that she was involved in a brawl and was repeatedly kicked. Bruising is noted over her abdomen and legs. She is bleeding heavilty and complaining of severe abdominal pain. A bradycardic fetal heart rate is audible with Doppler. Preparations are made for stat C/S due to the maternal hemorrhage. Presumptive diagnosis is abruption placenta. The emergent procedure is performed under general anesthesia. The newborn requires vigorous resuscitation and blood replacement. The mother continues to bleed heavily. Coagulation studies verify DIC.

1. The nursing priority in this situation is to
   1. Notify the next of kin to obtain telephone permission for treatment
   2. Prepare the client for emergency surgery
   3. Obtain blood for type and crossmatch
   4. Complete the admission paperwork

2. A compromised neonate should be expected because
   1. Maternal pain associated with abruption can cause fetal hypercarbia
   2. Abruption decreases the placental surface area available for perfusion
   3. The cord will be compressed due to the abruption
   4. The fetus will aspirate blood from the amniotic fluid

3. Which lab results are consistent with DIC
   1. Thrombocytopenia
   2. Decreased hemoglobin
   3. Positive FSP’s
   4. All of the above

4. General anesthesia is appropriate in this situation because
   1. She is not able to sit up for an epidural due to pain
   2. Vasodilation related to regional anesthesia could lower her B/P
   3. General anesthesia can be accomplished faster than spinal anesthesia
   4. General anesthesia permits better control of bleeding

5. Evidence of DIC could include
   1. Facial petechiae
   2. Incisional bleeding
   3. Bruising from the pressure of the B/P cuff
   4. All of the above

Answer 1