A nurse is performing a digital examination on a client who is at 34 weeks of gestation and has pre-term labor.

Which of the following findings indicates cervical effacement?

Cervix is soft and pliable

Cervix is shortened and thinned

Cervix is dilated and open

Cervix is posterior and high

Answer and Explanation

The Correct Answer is B

Cervix is shortened and thinned. This indicates cervical effacement, which is the thinning and softening of the cervix in preparation for childbirth. Cervical effacement is measured in percentages, from 0% (no effacement) to 100% (fully effaced).

Choice A is wrong because cervix is soft and pliable does not necessarily mean it is effaced. The cervix can soften before it thins and shortens.

Choice C is wrong because cervix is dilated and open indicates cervical dilation, which is the opening of the cervix. Cervical dilation is measured in centimeters, from 0 cm (closed) to 10 cm (fully dilated).

Cervical dilation and effacement are related, but not the same.

Choice D is wrong because cervix is posterior and high indicates the position of the cervix in relation to the vagina. The cervix can move from posterior (back) to anterior (front) and from high to low as labor progresses.

The position of the cervix does not indicate effacement.

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Correct Answer is C

Explanation

Report any increase in vaginal discharge to the provider.This is because an increase in vaginal discharge can indicate an infection, which can trigger preterm labor or cause complications for the mother and the baby.

Choice A is wrong because sexual intercourse is not contraindicated for women who have preterm labor that was successfully stopped with tocolytic therapy, unless they have other risk factors such as placenta previa or ruptured membranes.

Choice B is wrong because drinking at least 3 L of fluids per day is not necessary for women who have preterm labor that was successfully stopped with tocolytic therapy, unless they have dehydration or oligohydramnios.

Choice D is wrong because pelvic floor exercises are not recommended for women who have preterm labor that was successfully stopped with tocolytic therapy, as they can increase uterine activity and cause contractions.

Tocolytic therapy is the use of drugs to delay delivery for a short time (up to 48 hours) if a woman begins labor too early in her pregnancy.

The purpose of tocolytic therapy is to allow time for the administration of corticosteroids or other medicine.

A. Measure urine output B. Check deep tendon reflexes C. Assess uterine activity D. Monitor blood pressure

Correct Answer is C

Explanation

The therapeutic effect of magnesium sulfate is to inhibit uterine contractions and prevent or delay preterm labor.

By assessing uterine activity, the nurse can evaluate if the medication is working or not.

Choice A is wrong because measuring urine output is not directly related to the therapeutic effect of magnesium sulfate, but rather to monitor for toxicity and renal function.

Choice B is wrong because checking deep tendon reflexes is also not directly related to the therapeutic effect of magnesium sulfate, but rather to monitor for neuromuscular effects and toxicity.

Choice D is wrong because monitoring blood pressure is not directly related to the therapeutic effect of magnesium sulfate, but rather to monitor for cardiovascular effects and toxicity.

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A nurse is performing a digital examination on a client who is at 34 weeks of gestation and has pre-term labor. Which of the following findings indicates cervical effacement?

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A nurse is performing a digital examination on a client who is at 34 weeks of gestation and has pre-term labor.

Which of the following findings indicates cervical effacement?