Practice Quiz

CNM Certified Nurse Midwife

Category - Intrapartum

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A client in her third trimester is admitted to the unit after complaining of painless, bright red vaginal bleeding. Placenta previa is suspected. Which of the following actions of the nurse midwife is not appropriate during the admission?
  1. Prepare the patient for an ultrasound.
  2. Prepare equipment for bi-manual pelvic examination.
  3. Attach an external electronic fetal heart rate monitor.
  4. Order blood tests, including hemoglobin and hematocrit counts.
Explanation
Answer: B - Bi-manual pelvic examination is not an appropriate nursing action when caring for a client who may have placenta previa. Bi-manual pelvic examination involves the insertion of two fingers inside the vagina and one hand over the abdomen. This action may cause maternal and fetal hemorrhage. Instead, an ultrasound is used to verify the diagnosis. There may be an increased risk of fetal complications due to decreased oxygen supply to the brain, so it is essential to monitor the fetus with an external fetal heart monitor.
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