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Difficulty: MediumEstablishing Priorities

A triage nurse at an obstetrical clinic is reviewing overnight voicemail messages. Which client situation represents the highest clinical priority and requires an immediate callback?

  1. A client at 34 weeks gestation who describes a sudden onset of intense, continuous abdominal pain and a firm, rigid abdomenAnswer
  2. B
    A client at 11 weeks gestation who reports severe nausea and the inability to retain any liquids for the past 18 hours
  3. C
    A client at 28 weeks gestation who reports painless bilateral ankle swelling that resolves after resting with her legs elevated
  4. D
    A client at 38 weeks gestation who states she is having irregular pelvic cramping and observed a pink-tinged mucous discharge

Answer

The client at 34 weeks gestation who describes a sudden onset of intense, continuous abdominal pain and a firm, rigid abdomen.
The client presenting with sudden, intense abdominal pain and a rigid, board-like abdomen at 34 weeks gestation is exhibiting classic signs of placental abruption (abruptio placentae). This is a critical obstetrical emergency that can rapidly lead to severe maternal hemorrhage, hypovolemic shock, and fetal compromise, placing it at the highest priority for an immediate callback and emergency intervention.

Step-by-Step Solution

1
Analyze each client's presentation to distinguish between expected physiological pregnancy adaptations and pathological changes.
The clients at 28 weeks and 38 weeks gestation are experiencing normal, expected physiological changes (dependent edema and impending labor signs, respectively).
Eliminating stable, expected findings narrows down the choices to clients experiencing true clinical alterations.
2
Compare the remaining pathological presentations using the Airway-Breathing-Circulation (ABC) framework and the principle of acute versus chronic.
The client at 11 weeks is experiencing dehydration (a circulation/fluid volume issue, but subacute). The client at 34 weeks is presenting with signs of an active internal hemorrhage (an acute, immediate circulation threat).
The ABC framework dictates that immediate, acute threats to life and limb must take precedence over conditions that deteriorate more slowly.
3
Select the client with the most immediate life-threatening condition.
The client with the rigid, board-like abdomen and intense pain is prioritized.
These are classic signs of abruptio placentae (placental abruption), which can rapidly lead to severe maternal hypovolemic shock and fetal hypoxia.

Key Concept

Prioritizing acute, life-threatening obstetrical emergencies (such as placental abruption) over subacute conditions or expected physiological adaptations of pregnancy.
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Establishing Priorities

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