A nurse is assisting with the admission of a client who is at 39 weeks of gestation and has heavy vaginal bleeding. Which of the following actions should the nurse take?

Choice A rationale Antibiotics are indicated if there is evidence of infection or if the membranes have been ruptured for an extended period to prevent chorioamnionitis. However, in the presence of heavy vaginal bleeding at 39 weeks, the most immediate threat is maternal or fetal hemorrhage from conditions like placenta previa or placental abruption. Administering antibiotics does not address the acute hemodynamic crisis or the need for immediate delivery to save the mother and the infant. Choice B rationale This medication is primarily used as a tocolytic to stop preterm labor or as an anticonvulsant for patients with preeclampsia or eclampsia. It is not a treatment for heavy vaginal bleeding in a term pregnancy. In fact, magnesium sulfate can cause vasodilation and potentially worsen the clinical picture if the bleeding is related to a placental issue. The priority is stabilizing the patient and moving toward delivery rather than administering this specific medication. Choice C rationale Heavy vaginal bleeding in the third trimester is a medical emergency that often indicates placental abruption or placenta previa. These conditions can lead to rapid maternal exsanguination and fetal hypoxia. A cesarean birth is the definitive treatment to stop the bleeding and deliver the fetus safely when the mother is at term. Preparation must happen immediately to ensure that surgical intervention can occur as soon as the medical team is ready. Choice D rationale Performing a digital cervical examination is strictly contraindicated in the presence of unexplained heavy vaginal bleeding during late pregnancy. If the client has placenta previa, a digital exam can puncture the placenta, leading to catastrophic and uncontrollable hemorrhage. The nurse must prevent anyone from performing this exam until the location of the placenta is confirmed via ultrasound. Requesting an RN to do this would be a dangerous and incorrect action.