# A nurse is caring for a client at 32 weeks gestation diagnosed with complete placenta previa who presents to the labor and delivery unit with bright red vaginal bleeding. Which nursing intervention should be the priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542941  
> language: ko  
> subject: Maternal Newborn Health

## 문제

A nurse is caring for a client at 32 weeks gestation diagnosed with complete placenta previa who presents to the labor and delivery unit with bright red vaginal bleeding. Which nursing intervention should be the priority?

## 보기

1. Perform a sterile vaginal examination to assess cervical dilation and effacement
2. Administer prescribed opioid analgesic for maternal comfort and pain relief
3. Position the client in left lateral recumbent position and initiate continuous fetal monitoring **✔ 정답**
4. Encourage ambulation to promote maternal circulation and venous return

**정답: 3**

## 해설

In placenta previa with active bleeding, priority is to optimize maternal-fetal circulation and monitor fetal well-being. Left lateral positioning improves venous return, and continuous fetal monitoring detects compromise. Other options (vaginal exam, pain meds, ambulation) are contraindicated or lower priority as they may worsen bleeding or delay monitoring.

## 심화 해설

Clinical Judgment
This question evaluates the nurse's priority setting in a situation of active bleeding due to Placenta Previa. The core is to maximize stabilization and monitoring of the maternal and fetal condition without worsening the hemorrhage. Option 3 (**Left lateral position and continuous fetal monitoring**) is the optimal initial intervention that achieves both goals simultaneously. The left lateral position reduces compression of the inferior vena cava, improving maternal cardiac output and placental perfusion, while continuous fetal monitoring allows detection of immediate changes in fetal status (hypoxia, possible placental abruption). The other options either provoke bleeding (sterile vaginal exam), are inappropriate for the situation (pain medication, ambulation), or are of secondary importance.

Memory Tip
For placenta previa hemorrhage, remember **N**o **P**elvic **E**xams, **M**onitor & **P**osition (**NPEMP**)

- **N**o: No vaginal exams (risk of worsening hemorrhage)

- **P**osition: Left lateral position

- **E**mergency: Prepare for emergency delivery

- **M**onitor: Continuous monitoring of maternal VS and fetal heart rate

- **P**repare: Secure IV line, prepare blood type testing

KR vs US
In Korea, there is a tendency to emphasize early hospitalization and absolute bed rest after a placenta previa diagnosis, but the US NGN/CJMM focuses on immediate judgment and intervention (position change, monitoring, avoiding invasive procedures) in emergency situations with active bleeding. Also, the importance of fetal monitoring is heavily emphasized, with continuous electronic fetal monitoring (EFM) established as a standard protocol.

## 임상 시나리오

Clinical Practice Guide
1.  Notify HCP! For a patient with placenta previa who is actively bleeding, immediately report to the physician and begin preparing for an emergency Cesarean section.
2.  Critical Cue: **Never perform a sterile vaginal examination.** This can further damage the placenta and cause fatal hemorrhage. Cervical assessment should only be done via ultrasound if needed.
3.  Basic interventions: Position the patient in the left lateral recumbent position, administer oxygen, secure two large-bore IV lines (16-18G), provide fluid resuscitation, closely monitor vital signs and the amount of bleeding, and prepare for blood type testing and crossmatching.

Caution
In a SATA (Select All That Apply) question like "Which nursing interventions are appropriate for a patient with placenta previa?", "performing a vaginal examination" is never included. Conversely, "left lateral recumbent position," "fetal monitoring," "assessing the amount of bleeding," and "securing an IV line" are correct answers. "Pain management" is a lower priority unless abdominal pain is present (placenta previa is characterized by painless bleeding).

## 핵심 개념

- **Placenta Previa (태반 전치)** — The placenta is attached to the lower part of the uterus, partially or completely covering the internal cervical os. Painless, bright red vaginal bleeding is the characteristic symptom.
- **Vasa Previa (태반 혈관 전치)** — A rare condition where the umbilical cord vessels cross between the fetal membranes, covering the internal cervical os in front of the fetal presenting part. If the membranes rupture, the fetal vessels can tear, leading to rapid fetal hemorrhage.
- **Inferior Vena Cava (IVC) Syndrome (하대정맥 압박 증후군)** — A condition in late pregnancy where the enlarged uterus compresses the inferior vena cava when the mother lies supine, reducing venous return and cardiac output. Prevented and treated by positioning in the left lateral recumbent position.
- **Electronic Fetal Monitoring (EFM) (전자 태아 감시)** — A device that continuously records the fetal heart rate and uterine contractions. It is used to assess fetal well-being during high-risk pregnancies or labor.
- **Abruptio Placentae (태반 조기 박리)** — A condition where the normally positioned placenta partially or completely detaches from the uterine wall before delivery. It is characterized by painful dark red bleeding and must be distinguished from placenta previa.

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