A nurse is caring for a client who is at 35 weeks of gestation and has moderate abruptio placenta. Which of the following actions should the nurse take?

Choice A rationale For a client with moderate abruptio placenta, which involves premature separation of the placenta from the uterine wall, the primary concern is fetal well-being due to impaired oxygen and nutrient exchange, and maternal hemorrhage. Therefore, continuous monitoring of fetal heart rate (FHR) tracings is a priority to assess for signs of fetal compromise (e.g., late decelerations, bradycardia, nonreassuring patterns) and determine the urgency for delivery. Choice B rationale Ferning is a microscopic test where a sample of vaginal fluid is allowed to dry on a slide; the characteristic fern pattern indicates the presence of amniotic fluid. This test is used to confirm rupture of membranes. This is not the immediate priority intervention for abruptio placenta, which is focused on managing hemorrhage and fetal distress, and a vaginal examination may be contraindicated if bleeding is severe. Choice C rationale Assessing for cervical dilation requires a vaginal examination. While important for determining labor progression, a vaginal examination is often contraindicated in the setting of unexplained vaginal bleeding until a placenta previa is ruled out by ultrasound, as a digital exam could potentially cause a severe hemorrhage if the placenta is covering the cervix. The FHR is a higher priority. Choice D rationale Administering oxytocin is a uterotonic agent used to induce or augment labor. In moderate to severe abruptio placenta, if the client is not in active labor or the bleeding is significant, emergency cesarean delivery might be required. Furthermore, the goal is often to deliver the fetus as quickly and safely as possible; oxytocin is not the initial management and could increase uterine tone, potentially worsening the abruption if not used carefully under close monitoring.