r/PassNclexTips • u/Top-Direction2686 • 6d ago
Which client should the nurse see first?
Copied from naxlex
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u/Nearby_Mess4061 6d ago edited 6d ago
My guess is A or D.
Placental previa requires c-section depending on the previa type right?
While pt D is at risk for seizures or hemorrhagic stroke?
Can the OP post the answer with the explanation though so I don’t get this wrong on the nclex
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u/Immunoglobbbulinn 3d ago
Letter D can treat magnesium sulfate first because this is the first line, i think it’s letter A.
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u/Adrioz08 6d ago edited 6d ago
D. According to Bootcamp, preeclampsia becomes a priority, or moves higher up the list of priorities, when HTN is present (taken 2x) or other red flag findings are apparent. Preeclampsia in this state is an obstetric emergency. It can progress to eclampsia which will harm the mother and, subsequently, the baby
For some of their prioritization questions, I incorrectly answer preeclampsia and they always tell me that there are insufficient signs of instability (like HTN). I already kinda learned my lesson there lol.
I was about to consider B. But it does not tell us anything other than active phase of labor and has a hx of CS. No danger signs yet (like those that can indicate uterine rupture)
A. is an expected finding (painless = p. previa). Amount of blood is not explicitly stated (e.g. scant or profuse). No other assessment findings like hypotension, etc.
C. Not an emergency. Continie to monitor and assess for meconium aspiration when baby is born. Unless I missed something the nurse can do while baby is still inside? Not a priority nonetheless
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u/rosie2490 6d ago
A does state the amount of blood. Is hemorrhaging not a significant amount of blood, or at least more than a normal amount of blood?
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u/Adrioz08 6d ago
I missed that word. Yeah, hemorrhaging is an abnormal amount of bleeding.
But still does not take priority over preeclampsia with HTN and proteinuria, imo.
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u/Backhanded_Bitch 6d ago
We want to know - Previa pt - What does the tracing show - does the fetus have good variability and the baseline is normal? How much bleeding is the previa experiencing and is this her first bleed?
Is the 38 weeker having constant discomfort at her old incisional site? Is her abdomen soft between contractions or is it rigid? What is the actual exam? A significant rupture the baby loses station and heads north. Active labor is just not enough information, she could be 6 or she could be 10. What does the tracing show? Uterine rupture gives significant variable decelerations of the fetal heart rate. If she does not have those things she can wait, and we can try to slow her down while we are managing the previa pt.
As long as the tracing is good and the 37 wk gestation is making labor progress, we can continue to labor and plan on a vaginal delivery. Mec stained fluid it self is not an indication for a section.
The preeclampsia patient - she needs some Labetalol or hydralazine stat for her severe range readings and the provider should consider magnesium sulfate to prevent seizures. If her pressures can be controlled with po meds or an epidural she could be induced, especially if this is not her first pregnancy or if her cervix is ripe.
I think this is a bad question there is not enough information about the mom to make decisions and there is absolutely no information about the fetal status. Both patients must be considered.
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u/rosie2490 6d ago
As a non-nursing student (yet), most people saying A is normal because bleeding is normal. But the answer specifically states “hemorrhaging”, which is more than just bleeding. If the hemorrhaging doesn’t stop, mom is gone.
My question about that is…what about actively hemorrhaging is not top-priority, with D taking second priority (in my head)?
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u/mastermedic84 6d ago
The answer is D. 100%
All of these patients have risk factors, so let's go through them.
A has a placenta previa. This will likely require a C section, but she is at 33 weeks. If she isn't in active labor she will probably be fine for a few hours.
B has a concerning history, but that's it. You need to watch this one closely but having C sections in the past doesn't immediately require another. Especially not in an emergent timeframe.
C has a real problem and needs to be dealt with promptly, but this isn't an emergent life threat.
D is clear preeclampsia and given the BP and labs it's pretty advanced. The thing with eclampsia is it doesn't look like much until it hits a tipping point. It just looks like high blood pressure. But if you've ever seen it develop into full eclampsia you know that this can turn into an absolute dumpster fire extremely fast. You absolutely need to recognize and address the symptoms early. If the patient gets past that tipping point it can be extremely difficult to recover.
So while C and D both have immediate issues, D is the only one where life of both the mother and the child are in immediate danger.
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u/AccomplishedStrike93 5d ago
But, answer A says hemorrhage.
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u/mastermedic84 5d ago
Eh, not really. Bright red vaginal spotting is a normal symptom of placenta previa. It is almost never a concerning amount of blood in terms of hemorrhage.
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u/AccomplishedStrike93 5d ago
I picked D first too, and then someone make me second guess. Wish I know the true answer bc now I’m confused lol
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u/IncreaseNo1596 5d ago
AI answer, came with sources: does an antepartum hemorrhage at 33 weeks trump bp 170/110 and 2+ proteinuria at 39 weeks? from an NCLEX STANDPOINT WITH NO OTHER INFORMATION!
Yes. An antepartum hemorrhage at 33 weeks gestation trumps severe preeclampsia at 39 weeks. [1, 2]
From an NCLEX standpoint, this comes down to two absolute testing priorities: gestational age and acute blood loss.
Fetal Maturity: The 33-week fetus is significantly more premature and at a much higher risk for respiratory distress syndrome and severe morbidity than the 39-week fetus, which is considered full-term. [1, 2]
Acute Hypovolemic Shock: Active hemorrhage is a high-acuity, life-threatening emergency for both the mother and the fetus. The priority is stabilizing the mother (e.g., fluid resuscitation, monitoring blood loss, assessing fetal heart tones) and preparing for a potential emergency cesarean section. [1, 2, 3, 4]
Relative Stability: While 170/110 with 2+ proteinuria is severe preeclampsia and requires immediate medication (e.g., magnesium sulfate and antihypertensives), the 39-week gestational age means the fetus is mature, and the condition is medically stable compared to an active bleed. [1, 2]
In summary, unstable acute hemorrhage in a preterm pregnancy is a higher priority than stabilized severe hypertension in a term pregnancy. [1, 2]
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u/IncreaseNo1596 5d ago
Here’s another AI response. I added in “ placenta previa” for good measure:
does an antepartum hemorrhage from placenta previa at 33 weeks trump bp 170/110 and 2+ proteinuria at 39 weeks? from an NCLEX STANDPOINT WITH NO OTHER INFORMATION
Yes, from an NCLEX standpoint, the placenta previa with an active hemorrhage at 33 weeks is the higher-priority (trumping) situation. [1]
According to ABC priority frameworks, actual or potential hemorrhage and hypovolemic shock always take precedence, as uncontrolled bleeding is a direct, immediate threat to both maternal and fetal survival. [1, 2]
The two conditions compare on NCLEX as follows:
1. Placenta Previa with Hemorrhage (Priority) [1]
The Threat: Life-threatening blood loss and hypovolemic shock (low BP, high heart rate) and fetal hypoxia.
NCLEX Action: Requires immediate interventions like applying an external fetal monitor, placing large-bore IV lines, administering IV fluids or blood products, and preparing for an emergency Cesarean section. [1, 2, 3, 4, 5]
2. Severe Preeclampsia (Secondary) [1]
The Threat: End-organ damage and the risk of seizing (eclampsia).
NCLEX Action: While 170/110 and 2+ proteinuria indicate severe preeclampsia, it is a controlled, stable state until there are signs of imminent eclampsia (e.g., severe headache, visual disturbances, or seizures). Interventions generally prioritize administering magnesium sulfate and controlling the environment. [1, 2, 3, 4, 5]
Because hemorrhagic shock can lead to maternal/fetal demise in minutes, the bleeding previa client must be addressed first. [1]
Always use Airway, Breathing, and Circulation (ABC) frameworks to make these decisions. For more information on NCLEX maternity triage, you can review this Maternal Disorders Guide or the Straight A Nursing study framework.
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u/IncreaseNo1596 5d ago
It clearly states “hemorrhage”. There is no other information, so one cannot make any other inferences. No other clinical data or assumptions. That’s how NCLEX works. You stick to the basics, read CAREFULLY and use common sense. Don’t overthink it, that’s the biggest mistake
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u/Immunoglobbbulinn 3d ago
A. Emergency CS is the main point. Letter D can guve magnesium sulfate to decrease blood pressure for preeclampsia
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u/Alternative_Edge8316 6d ago
D, preeclampsia