A pregnant client arrives in the labor and delivery unit with mild contractions and brisk, painless vaginal bleeding. The client received no prenatal care and reports being "about 7-8 months." Which actions should the nurse anticipate? Select all that apply.

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11ecbb05_cbf2_cc27_b433_a75d51cbd1a5_MD0009_00 Placenta previa is an abnormal implantation of the placenta resulting in partial or complete covering of the cervical os (opening). The condition is diagnosed by ultrasound. In clients reporting painless vaginal bleeding after 20 weeks gestation, placenta previa should be suspected. Placenta previa found early in pregnancy may resolve by the third trimester, but women with persistent placenta previa or hemorrhage require cesarean birth. A type and screen to determine blood type and Rh status is appropriate due to the potential for excessive blood loss and need for blood transfusion (Option A). Fetal well-being is assessed via continuous electronic fetal monitoring to help determine appropriate timing for birth (Option B). Large-bore IV access is established in anticipation of fluid resuscitation and administration of blood products (Option C). The client should also be monitored frequently for any changes in bleeding via pad counts (Option D). (Option E) Digital vaginal examinations are contraindicated in the presence of vaginal bleeding of unknown origin. When placenta previa is present, manual manipulation of the cervix can damage placental blood vessels, causing subsequent bleeding that can progress to hemorrhage. Clients with placenta previa are on pelvic rest (ie, no intercourse, nothing per vagina). Educational objective: Placenta previa is suspected in clients reporting painless vaginal bleeding after 20 weeks gestation. Clients with placenta previa are at high risk for hemorrhage. The nurse should initiate electronic fetal monitoring and pad counts, draw a type and screen, and initiate large-bore IV access. Digital vaginal examinations are contraindicated.

A Pregnant Client Arrives in the Labor and Delivery Unit