A nurse is providing education to a client on how to care for their cast.
Which of the following instructions should the nurse include?

Choice A rationale

Contractions that increase in intensity are a hallmark of true labor. In true labor, uterine contractions become stronger, more regular, and longer in duration due to increasing myometrial activity and prostaglandin release, which contribute to cervical effacement and dilation. This differs from Braxton Hicks contractions, which typically remain mild.

Choice B rationale

Leakage of fluid from the vagina, often referred to as rupture of membranes, signifies the spontaneous breaking of the amniotic sac. This event can occur before or during true labor and increases the risk of infection and cord prolapse. It is a definitive sign that the labor process has begun or is imminent.

Choice C rationale

Increased bladder pressure is a common discomfort experienced by pregnant clients due to the growing uterus compressing the bladder. However, it is not a specific indicator of true labor. It can occur throughout the third trimester as the fetal head descends into the pelvis, regardless of labor onset.

Choice D rationale

Blood-tinged vaginal mucus, also known as "bloody show," results from the softening and effacement of the cervix, causing capillaries to rupture and release a small amount of blood mixed with mucus. This is a common sign indicating that the cervix is undergoing changes in preparation for labor.

Choice E rationale

Uterine contractions that decrease with rest are characteristic of Braxton Hicks contractions, or "false labor.”. True labor contractions, in contrast, persist and often intensify with activity and do not diminish with rest or changes in position, reflecting progressive physiological changes of labor.

Choice A rationale

Lateral curvature of the spine, known as scoliosis, can occur in Duchenne muscular dystrophy (DMD) as a secondary complication due to progressive muscle weakness affecting the spinal support. However, it is not the primary or initial characteristic manifestation of the disease. The fundamental pathology of DMD is direct muscle fiber degeneration leading to weakness.

Choice B rationale

Joint inflammation is characteristic of inflammatory arthropathies, such as juvenile idiopathic arthritis. Duchenne muscular dystrophy is a primary myopathy, a disorder of muscle tissue itself, not a condition primarily involving inflammation of the joints. While secondary musculoskeletal issues can arise, joint inflammation is not a hallmark feature of the disease.

Choice C rationale

Duchenne muscular dystrophy is an X-linked recessive disorder characterized by the absence of dystrophin, a crucial protein for maintaining muscle fiber integrity. This leads to progressive degeneration of skeletal muscle fibers, resulting in escalating muscle weakness. This weakness typically manifests in early childhood, starting in the proximal muscles and gradually spreading, leading to loss of ambulation.

Choice D rationale

While severe muscle weakness in Duchenne muscular dystrophy can indirectly lead to some skeletal deformities over time, such as contractures and kyphoscoliosis, these are typically secondary consequences rather than primary manifestations. The direct and defining characteristic of the disease is the progressive degeneration and weakness of the muscles themselves.