A nurse midwife is examining a client who is primigravida at 42 weeks of gestation and states that she believes she is in labor. Which of the following findings confirm to the nurse that the client is in labor?

Choice A rationale
This is incorrect because a client who has missed a period and reports vaginal spotting is not the most urgent case. This could indicate a possible pregnancy or a menstrual irregularity, but it is not a life-threatening condition. The nurse should see this client after assessing the other clients.

Choice B rationale
This is correct because a client who is at 28 weeks of gestation and reports painless vaginal bleeding is the most urgent case. This could indicate a placenta previa, which is a condition where the placenta covers the cervical opening and can cause severe hemorrhage and fetal distress. The nurse should see this client immediately and prepare for an emergency cesarean section.

Choice C rationale
This is incorrect because a client who is at 38 weeks of gestation and reports a cough and fever is not the most urgent case. This could indicate a respiratory infection, which can affect the maternal and fetal well-being, but it is not a life-threatening condition. The nurse should see this client after assessing the other clients and administer antibiotics and antipyretics as prescribed.

Choice D rationale
This is incorrect because a client who is at 14 weeks of gestation and reports nausea and vomiting is not the most urgent case. This could indicate a normal pregnancy symptom or a hyperemesis gravidarum, which is a condition where the nausea and vomiting are severe and persistent. The nurse should see this client after assessing the other clients and provide hydration and antiemetics as prescribed.

Choice A rationale
This is correct because a client who has a diagnosis of preeclampsia reports epigastric pain and unresolved headache is the most urgent finding. These are signs of severe preeclampsia, which can progress to eclampsia, a life-threatening condition that involves seizures, coma, and organ damage. The nurse should report this finding to the provider immediately and prepare for the delivery of the fetus and the administration of magnesium sulfate to prevent seizures.

Choice B rationale
This is incorrect because a client who has a diagnosis of preeclampsia has 2+ proteinuria and 2+ patellar reflexes is not the most urgent finding. These are signs of mild preeclampsia, which can be managed with close monitoring, bed rest, and antihypertensive medications. The nurse should report this finding to the provider, but it is not an emergency.

Choice C rationale
This is incorrect because a client who is at 28 weeks of gestation and receiving terbutaline reports fine tremors is not the most urgent finding. These are side effects of terbutaline, a medication that is used to stop preterm labor by relaxing the uterine muscles. The nurse should assess the client's vital signs, blood glucose, and fetal heart rate, and report any abnormal findings to the provider. The nurse should also reassure the client that the tremors are temporary and will subside when the medication is discontinued.

Choice D rationale
This is incorrect because a tearful client who is at 32 weeks of gestation and is experiencing irregular, frequent contractions is not the most urgent finding. These are signs of preterm labor, which can be treated with tocolytic medications, such as terbutaline, to delay the delivery until the fetus is more mature. The nurse should assess the client's cervical dilation, fetal heart rate, and amniotic fluid, and report any abnormal findings to the provider. The nurse should also provide emotional support and education to the client.