A client at 34 weeks with placenta previa is bleeding. The fetal heart sounds are normal and the client is not in labor. Which nursing intervention should the nurse perform?

• A. Monitor the amount of vaginal blood loss.
• B. Prepare the client for immediate cesarean delivery.
• C. Assist to ambulate to promote comfort.
• D. Apply heat to the abdomen or perineum.

Answer: (B)

Placenta previa means the placenta is implanted over or near the cervical os, which makes vaginal delivery dangerous because bleeding can worsen if labor begins or the cervix dilates. Even with reassuring fetal heart tones, active bleeding from placenta previa at 34 weeks requires delivering the fetus via cesarean to control maternal hemorrhage and prevent placental separation during labor. Therefore preparing for immediate cesarean delivery is the most appropriate nursing action.

In practice, the nurse should support this plan by coordinating with the obstetric team and ensuring readiness for surgery: establish two large-bore IV lines with fluids available, arrange for type and crossmatch and potential blood products, keep the patient NPO, continuously monitor maternal vital signs and bleeding, monitor the fetal status, and ensure rapid transfer to the operating room with appropriate consent and documentation.