A 48-year-old woman presents to the clinic reporting irregular periods for the past 6 months.

She states, "I wake up drenched in sweat almost every night, and during the day I suddenly feel like I'm on fire!" The nurse recognizes these symptoms as characteristic of perimenopause.
Which symptom should the nurse address as the PRIORITY concern based on frequency of occurrence?

Hot flashes and night sweats.

Increase in menstrual cramping.

Frequent loose stools.

Breast tenderness.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Hot flashes and night sweats, known as vasomotor symptoms, are the hallmark indicators of perimenopause occurring in up to 80.

Choice B rationale

An increase in menstrual cramping is not a primary or most frequent characteristic of perimenopause. While menstrual cycles become irregular in length and flow due to anovulatory cycles, cramping usually decreases as ovulation becomes less frequent. Primary dysmenorrhea is typically associated with ovulatory cycles where prostaglandin release is high. If a woman experiences new, severe cramping, clinicians should investigate other pathologies like fibroids or adenomyosis rather than attributing it to normal perimenopausal transition.

Choice C rationale

Frequent loose stools are not a classic or frequent symptom of perimenopause. While hormonal shifts can sometimes affect the gastrointestinal system or exacerbate conditions like irritable bowel syndrome, they are not a priority concern or a diagnostic hallmark of this stage. Normal bowel movements remain consistent unless there are secondary dietary changes or underlying medical issues. The nurse should focus on the well-documented vasomotor and psychological symptoms that define the perimenopausal experience.

Choice D rationale

Breast tenderness, or mastalgia, can occur during perimenopause due to erratic spikes in estrogen, but it is typically less frequent and less distressing than vasomotor symptoms. While it is a recognized symptom, it does not carry the same priority as hot flashes which can lead to chronic sleep deprivation and psychological distress. The nurse should monitor breast changes but prioritize the management of night sweats as they are the most common complaint reported.

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Correct Answer is B

Explanation

Choice A rationale

The five Ps framework includes Passenger, Passageway, Powers, Position, and Psychologic response. The fetal head position, specifically a persistent occiput posterior position, falls directly under the category of the Passenger. This refers to the fetus and its relationship to the maternal pelvis, including fetal presentation, lie, and attitude. Malpositions like occiput posterior can significantly slow labor progress because the larger diameter of the fetal head must navigate the pelvic bones, often leading to intense back labor.

Choice B rationale

Maternal blood pressure is a vital sign and a measure of cardiovascular stability, but it is not one of the five Ps of labor. While a blood pressure of 148/92 is elevated and requires clinical attention to rule out gestational hypertension or preeclampsia, it does not describe the mechanics or progress of labor itself. The five Ps are specifically designed to categorize factors that directly influence the birth process. Vital signs are part of the broader physical assessment rather than the labor framework.

Choice C rationale

The frequency and intensity of uterine contractions fall under the category of Powers. Primary powers refer to involuntary uterine contractions which are responsible for effacement and dilation of the cervix. In this case, contractions occurring every 7 minutes with mild intensity are a measure of the labor forces. If contractions are inadequate to produce cervical change, it represents a dysfunction in the powers, which is a key component of evaluating why a laboring woman might be progressing slowly.

Choice D rationale

The woman's anxiety and her request for her mother fall under the category of Psychologic response, which is the fifth P. A woman's emotional state, cultural background, and support system can significantly impact labor progress. High levels of anxiety can lead to increased catecholamine release, which can actually inhibit uterine activity and slow down labor. Therefore, assessing the mother's psyche and providing emotional support is a critical part of the five Ps framework used to evaluate laboring patients.

A. Unrepaired vaginal lacerations. B. Uterine atony. C. Puerperal infection. D. Vaginal or vulvar hematomas.

Correct Answer is B

Explanation

Choice A rationale

Unrepaired vaginal lacerations are a possible cause of postpartum hemorrhage, especially after a large baby. However, bleeding from a laceration is typically characterized by a firm uterus with bright red, continuous trickling of blood. In this scenario, the combination of a 9-pound infant and the use of Pitocin for augmentation points more strongly toward another physiological failure of the uterine muscle rather than a simple soft tissue tear in the birth canal.

Choice B rationale

Uterine atony is the most common cause of postpartum hemorrhage. It occurs when the uterine myometrium fails to contract effectively after delivery to compress the intramyometrial blood vessels. Risk factors in this patient include a large baby (9 pounds 7 ounces), which overstretches the muscle fibers, and the use of Pitocin, which can lead to muscle fatigue. Failure of the uterus to stay firm leads to rapid, heavy bleeding from the placental site.

Choice C rationale

Puerperal infection is a postpartum infection of the reproductive tract. While it is a serious complication, it typically manifests several days after delivery with symptoms like fever (greater than 100.4 F), foul-smelling lochia, and uterine tenderness. It is not the most likely cause of an acute, heavy bleeding episode occurring only 4 hours after birth. Hemorrhage from infection is usually a secondary, delayed event rather than an immediate primary cause of heavy lochia.

Choice D rationale

Vaginal or vulvar hematomas involve the collection of blood in the connective tissue of the pelvic soft tissues due to vessel damage. While they can be caused by the delivery of a large infant, the primary symptom is usually exquisite, deep pelvic pain or a feeling of rectal pressure rather than visible heavy external bleeding. Because the blood is trapped within the tissues, it does not typically present as the mother stating she is bleeding a lot.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a laboring woman whose labor is progressing slowly. Using the "five Ps" framework, the nurse evaluates multiple factors. Which assessment finding falls OUTSIDE the five Ps framework for labor?

Correct Answer is B

Explanation

A 25-year old gravida 2, para 2-0-0-2 gave birth 4 hours ago to a 9-lb, 7-ounce boy after augmentation of labor with Pitocin. She puts on her call light and asks for her nurse right away, stating "I'm bleeding a lot.”. The most likely cause of after birth hemorrhage in this woman is.

Correct Answer is B

Explanation

A woman is 3 months pregnant. At her prenatal visit, she tells the nurse that she does not know what is happening; one minute she's happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate?

A 52-year-old perimenopausal woman asks the nurse, "Now that I'm going through the change, what health problems should I watch out for?" Which response by the nurse addresses the MOST significant long-term health risk associated with this life stage?

A nurse is caring for a woman at 32 weeks gestation who asks why she needs to lie on her side during the nonstress test. Using knowledge of placental function, which explanation by the nurse is MOST accurate?

The nurse guides the woman into the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman states "I have special undergarments that I do not remove for religious reasons.”. The most appropriate response from the nurse would be:

A breastfeeding mother asks the nurse, "Why do I feel so relaxed and sleepy every time I nurse my baby?". The nurse should explain that this sensation is related to which hormone that remains elevated in breastfeeding women?

A woman at 38 weeks gestation tells the nurse, "I can finally breathe better, but now I feel pressure in my pelvis and I'm running to the bathroom constantly!" The nurse explains this is called lightening. Which physiologic event is occurring?

A nurse assessed a fetus with an average heart rate of 135 beats/min over a 10-minute period during labor. The nurse would document this observation to be:

A nurse is assisting a full-term primigravida during labor and heard the patient's health care provider say that the fetus is not yet engaged and needs intervention. Which passenger position would probably be interfering with a safe vaginal birth?