A practical nurse is reinforcing education with a newly licensed nurse regarding visceral pain during labor.
Which of the following causes of pain by the newly licensed nurse would require follow-up?
Cervical dilation.
Stretching of the pelvic muscles.
Nerve stimulation.
Uterine contractions.
The Correct Answer is B
Choice A rationale
Cervical dilation is a source of visceral pain during labor due to the stretching and opening of the cervix, and it is not incorrect information.
Choice B rationale
Stretching of the pelvic muscles is incorrect because visceral pain during labor is typically associated with internal organs and not the stretching of pelvic muscles, which is more somatic pain.
Choice C rationale
Nerve stimulation is a cause of visceral pain as labor pain is transmitted through the nerves to the spinal cord and brain.
Choice D rationale
Uterine contractions are a major source of visceral pain during labor as they involve the powerful and rhythmic tightening and relaxing of the uterine muscles.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Checking the client's temperature every 4 hours is important to monitor for infection but is not the primary action during the active phase of labor following an amniotomy.
Choice B rationale
Encouraging the client to empty the bladder every 2 hours helps prevent bladder distention, which can impede the descent of the baby and contribute to labor progress.
Choice C rationale
Bearing down with each contraction is advised during the second stage of labor, not the active phase of the first stage.
Choice D rationale
Maintaining the client in the lithotomy position is not necessary throughout labor and can be uncomfortable; mobility and changing positions are encouraged.
Correct Answer is A
Explanation
Choice A rationale
Heavy vaginal bleeding at 39 weeks of gestation could be due to placental abruption or placenta previa, which necessitates immediate delivery to prevent maternal and fetal complications. Preparing for cesarean birth is crucial as it allows rapid delivery, reducing the risk of maternal hemorrhage and fetal hypoxia.
Choice B rationale
Performing a cervical examination can exacerbate bleeding in cases of placenta previa or placental abruption, making it unsafe. It can disturb the placenta and lead to further complications, so this option is not recommended.
Choice C rationale
Magnesium sulfate is used to prevent seizures in preeclampsia or eclampsia, not for managing heavy vaginal bleeding. Its use is unrelated to the immediate care of a client with heavy vaginal bleeding due to suspected placental issues.
Choice D rationale
Administering antibiotics is not the immediate priority in the case of heavy vaginal bleeding at 39 weeks of gestation. The focus should be on stabilizing the mother and preparing for delivery.
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