A nurse is reviewing the laboratory results of a client who is at 29 weeks of gestation and has pre-term labor.

Which of the following results indicates an infection that can trigger pre-term labor?

“I will call my doctor if I have more than four contractions in an hour.” This statement indicates that the client understands the signs of preterm labor and when to seek medical attention.Preterm labor is defined as having regular contractions and cervical changes before 37 weeks of gestation.More than four contractions in an hour may indicate that preterm labor is occurring and requires prompt evaluation.

Choice A is wrong because drinking at least eight glasses of water every day is not a specific instruction for preventing preterm labor.However, dehydration can trigger contractions and should be avoided.

Choice B is wrong because lying on the back with a pillow under the knees can reduce blood flow to the uterus and the baby.This position can also increase the risk of blood clots in the legs.A better position is lying on the left side, which improves circulation and reduces pressure on the cervix.

Choice C is wrong because avoiding sexual intercourse until reaching term is not necessary for most women with a history of preterm labor.Sexual activity does not cause preterm labor or premature rupture of membranes (PROM).However, some women may be advised to abstain from sex if they have certain conditions, such as placenta previa or a short cervix.

Assess the client’s vital signs.

The nurse should first assess the client’s vital signs to determine the severity of the situation and identify any signs of infection, bleeding, or shock.

The nurse should also monitor the fetal heart rate to assess fetal well-being.

Choice B is wrong because a sterile vaginal exam is not indicated for a client who reports lower abdominal cramping and may increase the risk of infection or rupture of membranes.

Choice C is wrong because administering tocolytic medication is not the first action the nurse should take.

Tocolytic medication may be used to inhibit uterine contractions and prolong pregnancy, but only after assessing the client’s and fetus’s condition and obtaining a prescription from the provider.

Choice D is wrong because monitoring the fetal heart rate is not the first action the nurse should take.

Monitoring the fetal heart rate is important to assess fetal well-being, but it does not take priority over assessing the client’s vital signs.