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Difficulty: HardAnte/Intra/Postpartum and Newborn Care

A practical nurse (PN) is assisting a registered nurse (RN) in caring for a client at 34 weeks gestation who presents to the emergency obstetrical triage. The client reports sudden, excruciating abdominal pain. The PN observes that the client's abdomen is rigid and board-like to the touch, and there is no visible vaginal bleeding. The client's vital signs are: heart rate 118 beats/minute, respiratory rate 24 breaths/minute, and blood pressure 104/62 mmHg. While the RN obtains emergency intravenous access, which action is the priority for the PN?

  1. Position the client in a lateral tilt and administer supplemental oxygen per emergency protocol.Answer
  2. B
    Administer a prescribed intravenous push analgesic to help alleviate the severe pain.
  3. C
    Perform deep abdominal palpation to identify the exact point of maximum tenderness.
  4. D
    Record the vital signs as stable and wait for vaginal bleeding to occur before intervening.

Answer

The correct priority action is to position the client in a lateral tilt and administer supplemental oxygen per emergency protocol.
Positioning the client in a lateral tilt relieves pressure on the inferior vena cava, optimizing blood return to the heart and improving placental perfusion. Administering supplemental oxygen directly addresses the potential fetal hypoxia and maternal compensatory tachycardia (early shock) associated with a concealed placental abruption. These are immediate, life-saving ABC interventions that fall safely within the practical nurse's scope of practice while the RN establishes intravenous access.

Step-by-Step Solution

1
Analyze the clinical presentation.
A rigid, board-like abdomen with sudden severe pain and no visible bleeding at 34 weeks gestation strongly indicates a concealed placental abruption.
Recognizing the pathophysiology of a concealed hemorrhage is necessary to understand the risk of impending hypovolemic shock and fetal compromise.
2
Evaluate the maternal vital signs.
A resting heart rate of 118 beats/minute paired with a borderline blood pressure of 104/62 mmHg indicates early compensatory hypovolemic shock.
Tachycardia is often the earliest vital sign change in massive internal bleeding, requiring immediate physiological support.
3
Determine the priority intervention within the PN scope of practice.
The PN must initiate independent, in-scope interventions that support Airway, Breathing, and Circulation (ABCs) while the RN establishes advanced circulatory support (IV access).
Lateral positioning improves maternal cardiac return and placental perfusion, while supplemental oxygen combats fetal hypoxia, both of which are high-priority, in-scope actions.

Key Concept

Antepartum Complications (Placental Abruption) and Emergency Priority Setting
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Topics

Ante/Intra/Postpartum and Newborn Care

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