A nurse is monitoring a client who is in the active phase of labor and has an electronic fetal monitor.
Which of the following findings should the nurse expect?

Choice A rationale

Encouraging the client to listen to music is an effective non-pharmacological pain management strategy in the latent phase of labor. Music provides a distraction, promotes relaxation, and can help to reduce the perception of pain by stimulating the release of endorphins, fostering a calmer environment and coping mechanism.

Choice B rationale

Instructing the client on biofeedback is a complex technique that requires training and practice for effective use. While it can be beneficial, the latent phase of labor may not be the ideal time to introduce and teach a new skill like biofeedback, as the client's focus may be limited by contractions and discomfort.

Choice C rationale

Administering fentanyl 100 mcg every hour via intermittent intravenous bolus is a pharmacological intervention typically used for more intense pain in active labor or for clients who desire or require stronger pain relief. The latent phase is characterized by milder, less frequent contractions, making non-pharmacological methods or lower-dose analgesics more appropriate.

Choice D rationale

Requesting a pudendal nerve block is usually reserved for the second stage of labor, specifically for episiotomy repair or forceps delivery, rather than for pain management during the latent phase. It provides regional anesthesia to the perineum and lower vagina, not generalized pain relief for uterine contractions in early labor.

The nurse should identify that the client is at the greatest risk for preterm birth due to fetal fibronectin.

Rationale for correct answers:
Fetal fibronectin (fFN) is a glycoprotein found at the maternal-fetal interface, serving as a “biological glue” between the chorion and decidua. Normally, fFN is not detectable in cervicovaginal secretions between 22 and 34 weeks gestation. A level greater than 0.05 mcg/mL, such as this client’s 0.09 mcg/mL, signals disruption of the fetal membranes and an increased risk of preterm birth. It has a high negative predictive value, so a positive result strongly suggests premature labor risk, prompting interventions like tocolytics and corticosteroids to promote fetal lung maturity.

Rationale for incorrect Response 1 options:
Precipitous labor is rapid labor lasting under 3 hours from onset to delivery. Fetal fibronectin does not predict the speed of labor but the risk of preterm onset. This client’s labor is not precipitous based on exam and monitoring.

Chorioamnionitis is an intra-amniotic infection usually accompanied by maternal fever, uterine tenderness, and fetal tachycardia. Fetal fibronectin does not indicate infection.

Preeclampsia involves hypertension and proteinuria after 20 weeks and is unrelated to fetal fibronectin levels.

Rationale for incorrect Response 2 options:
Nitrazine and ferning tests assess membrane rupture. Both are negative here, indicating intact membranes, which does not exclude preterm labor but means premature rupture of membranes (PPROM) is unlikely.

Blood pressure measurements evaluate maternal hemodynamics, not risk of preterm birth.

Take-home points:

• Elevated fetal fibronectin (>0.05 mcg/mL) between 22-34 weeks indicates increased risk for preterm birth.
• Negative nitrazine and ferning tests suggest membranes are intact, helping differentiate preterm labor from PPROM.
• Preterm labor risk should be differentiated from precipitous labor, infection (chorioamnionitis), and hypertensive disorders like preeclampsia.
• Early identification of preterm labor risk allows timely administration of tocolytics and corticosteroids to improve neonatal outcomes.