A client at 10 weeks gestation provides the following obstetric history to the nurse at the first prenatal visit: elective abortion at age 17, a 5-year-old daughter born at 40 weeks gestation, and 3-year-old twin boys born at 34 weeks gestation.
Using GTPAL notation, which documentation appropriately describes the client's obstetric history?

Step 1: Heart rate of 110/min scores 2 points (normal heart rate >100).

Step 2: Slow weak cry scores 1 point (good strong cry scores 2, no cry scores 0).

Step 3: Some flexion of extremities scores 1 point (active movement scores 2, limp scores 0).

Step 4: Grimace in response to suctioning scores 1 point (coughing or sneezing scores 2, no response scores 0).

Step 5: Body pink, blue extremities scores 1 point (completely pink scores 2, completely blue or pale scores 0).

Step 6: Total Apgar score is the sum of the scores from each category: 2 + 1 + 1 + 1 + 2 = 7. Final calculated answer: 7.

Choice A rationale

The latent phase of labor is the longest and often the least intense phase, characterized by mild, infrequent contractions and gradual cervical dilation (0-3 cm). During this time, the woman is typically more receptive to learning and can concentrate better, making it the ideal phase to teach non-pharmacologic pain control methods such as breathing techniques, relaxation exercises, and positioning.

Choice B rationale

The active phase of labor (4-7 cm dilation) is characterized by more frequent and intense contractions, making it harder for the laboring woman to concentrate and learn new pain management techniques. Reinforcement of previously learned techniques is more appropriate at this stage.

Choice C rationale

The transition phase (8-10 cm dilation) is the most intense and shortest phase of the first stage of labor. The woman is likely experiencing significant discomfort and may have difficulty focusing on learning new pain control methods.

Choice D rationale

The second stage of labor begins with complete cervical dilation (10 cm) and ends with the birth of the baby. The focus during this stage is on pushing and delivering the baby, making it an inappropriate time to teach non-pharmacologic pain control methods for labor.