A nurse is conducting discharge teaching with a pregnant client at 32 weeks' gestation admitted to the facility with preterm labor that has been arrested.
The nurse determines that the teaching was successful based on which client statement?
It's safe for me to do any type of activity at home.
I need to remain on strict bed rest when I go home.
My contractions will be a lot stronger than the ones I have now when I go into labor.
I need to do a fetal kick count each day while at home.
The Correct Answer is D
Choice A rationale
Unrestricted activity is generally not safe after arrested preterm labor, as physical exertion can potentially stimulate uterine activity, risking recurrence of contractions and possible delivery. While strict bed rest is often not necessary, modified activity and pelvic rest are commonly advised to decrease physical stress and uterine irritability, thus promoting maintenance of the pregnancy until term.
Choice B rationale
Strict bed rest is generally not recommended for a client at home after arrested preterm labor, as prolonged immobility can lead to complications such as venous thromboembolism (VTE), muscle atrophy, and deconditioning. The standard recommendation is often modified rest or pelvic rest, restricting strenuous activities but allowing limited, necessary movement to maintain overall health and circulation.
Choice C rationale
The strength of future labor contractions is determined by complex physiological processes, including oxytocin receptor density and myometrial response, and is not necessarily correlated with the intensity of previous preterm contractions. Preterm contractions are often less efficient in cervical dilation due to gestational immaturity, and later, term contractions will be physiologically sufficient for delivery.
Choice D rationale
Fetal kick counts are a simple, non-invasive method for the client to assess fetal well-being and oxygenation at home. A decrease in fetal movement can be an early indicator of fetal distress or compromise, prompting the client to seek immediate medical evaluation. This self-monitoring technique is a crucial component of discharge teaching after a preterm labor scare.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["60"]
Explanation
Step 1 is: Convert the ordered rate from mU/min to mU/hr. 20 mU/min× 60 min/hr = 1200 mU/hr.
Step 2 is: Convert the available concentration from units/mL to mU/mL. 20 units = 20,000 mU (since 1 unit = 1000 mU). The concentration is 20,000 mU÷ 1000 mL = 20 mU/mL.
Step 3 is: Calculate the infusion rate in mL/hr. 1200 mU/hr÷ (20 mU/mL). 60 mL/hr. The oxytocin will infuse at 60 mL/hr.
Correct Answer is ["A","B"]
Explanation
Choice A rationale
Postpartum hemorrhage (PPH) is a significant risk for this client due to several factors including a macrosomic neonate (birth weight >4000 grams), which causes overdistention of the uterus. Uterine overdistention stretches the muscle fibers, impairing the uterus's ability to contract effectively (uterine atony) after birth, which is the leading cause of PPH (normal blood loss range: ≤ 500 mL for vaginal birth).
Choice B rationale
A rapid labor (4 hours) and the birth of a macrosomic neonate (4200 grams) increase the risk of vaginal lacerations and tears to the soft tissues of the birth canal. The rapid passage of a large fetal head/shoulder diameter can cause uncontrolled and forceful tearing, often extending into the perineal musculature, leading to potential complications and excessive blood loss.
Choice C rationale
Uterine inversion, the collapse of the fundus into the endometrial cavity, is a rare but severe complication. While associated with factors like aggressive cord traction or fundal pressure, this client's history of macrosomia and rapid labor primarily increases the risk for uterine atony and lacerations, making inversion a much less likely, though possible, complication.
Choice D rationale
Postpartum hypertension (PHTN) is generally related to a history of pre-eclampsia or chronic hypertension. This client's presentation of macrosomia and rapid labor primarily increases the risk for mechanical/anatomical complications like uterine atony and lacerations rather than a primary vasospastic or systemic vascular disorder such as PHTN.
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