A woman at 39 weeks gestation calls the clinic and reports: "I can breathe easier now, I've had some mucousy pink discharge, and I feel like the baby dropped!" The nurse recognizes these as signs that labor may begin soon.
Which of the woman's reported symptoms are premonitory signs of labor? Select all that apply.
Rupture of membranes.
Decreased fetal movement.
Exhaustion and inability to sleep.
Lightening (baby dropping).
Bloody show (mucousy pink discharge).
Correct Answer : D,E
Choice A rationale
Rupture of membranes is the tearing of the amniotic sac, often resulting in a gush or a steady trickle of fluid. While this frequently occurs during labor or just before it starts, it is considered a sign of the onset of labor rather than a premonitory sign. Premonitory signs are subtle physiological changes that suggest the body is preparing for labor in the near future. This event usually marks a more immediate transition into the active birthing process.
Choice B rationale
Decreased fetal movement is never considered a normal premonitory sign of labor. In fact, a decrease in fetal activity is a concerning finding that requires immediate clinical evaluation to rule out fetal compromise or hypoxia. A healthy fetus should remain active up until the start of labor and even during the early stages. Nurses should educate patients that while the baby may have less room, they should still feel regular movement and kicks.
Choice C rationale
While many women feel fatigued at the end of pregnancy, exhaustion is not a specific premonitory sign of labor. Conversely, some women experience a sudden "nesting instinct" or a burst of energy shortly before labor begins. General inability to sleep is often related to physical discomfort, frequent urination, or anxiety. Because it is common throughout the third trimester for many different reasons, it lacks the specificity needed to be a reliable indicator of impending labor.
Choice D rationale
Lightening occurs when the fetal presenting part descends into the true pelvis. This usually happens about two weeks before labor in primigravidas and can happen just before labor in multigravidas. This shift relieves pressure on the diaphragm, allowing the woman to breathe more easily, which matches the patient's report. It is a classic premonitory sign indicating that the fetus is in position and the body is preparing for the eventual onset of uterine contractions.
Choice E rationale
Bloody show refers to the passage of a small amount of blood-tinged mucus from the vagina. This happens as the cervix begins to thin and dilate, causing the mucus plug to be expelled and small capillaries to bleed. The patient reported a mucousy pink discharge, which perfectly describes this phenomenon. It is one of the most common signs that labor may begin within the next 24 to 48 hours as the cervix undergoes preliminary changes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Newborn care classes are specifically designed to provide evidence-based education on caring for an infant after delivery. These classes cover topics such as diapering, bathing, cord care, and recognizing signs of illness. For parents feeling nervous about baby care, these sessions provide hands-on practice and information that builds self-efficacy and reduces anxiety. This is the most appropriate recommendation for a couple specifically expressing concern about their ability to care for the upcoming baby.
Choice B rationale
Early prenatal care refers to the initial medical visits during the first trimester to monitor the health of the mother and fetus. At 34 weeks gestation, the patient is already in the third trimester, making early prenatal care classes irrelevant. While these classes cover nutrition and fetal development, they do not focus on the immediate practical skills of labor management or infant care that this couple requires in the final weeks of the pregnancy.
Choice C rationale
Preconception care is the medical care a woman receives before she becomes pregnant. Its goal is to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management. Since the patient is currently 34 weeks pregnant, this stage of care has long passed. Recommending preconception care does not address her current anxiety regarding the imminent delivery or the practicalities of newborn care.
Choice D rationale
Prenatal exercise classes focus on maintaining maternal physical fitness, improving circulation, and potentially easing some of the discomforts of pregnancy. While physical activity is generally beneficial, these classes do not provide the comprehensive education needed to manage anxiety regarding the labor process or the specifics of neonatal care. Exercise is a supplemental health activity rather than a primary educational tool for building confidence in delivery and infant care skills.
Correct Answer is B
Explanation
Choice A rationale
Offering an epidural as a definitive solution that eliminates all feeling is misleading and dismissive of the patient's emotional state. While an epidural provides significant pain relief, it does not address the underlying psychological fear or anxiety associated with the labor process. Furthermore, some women may still experience pressure or sensations even with an epidural. Providing false reassurances about complete numbness ignores the patient's need for emotional support and clear education regarding her birth plan.
Choice B rationale
Acknowledging that anxiety is normal validates the patient's feelings and opens a therapeutic dialogue. This response encourages the woman to express specific fears, allowing the nurse to provide targeted education and coping strategies. Therapeutic communication is essential for building trust and reducing maternal stress, which can positively impact labor outcomes. By discussing the fears, the nurse can address misconceptions and empower the patient with knowledge about the physiological process of labor and available pain management.
Choice C rationale
Telling a patient not to worry and that they will do fine is a form of non-therapeutic communication known as false reassurance. It minimizes the patient's legitimate concerns and may make her feel that her feelings are being ignored or undervalued. This approach shuts down further communication, preventing the nurse from identifying specific stressors or educational needs. In a clinical setting, valid fears should be met with empathy and factual information rather than generic platitudes.
Choice D rationale
Claiming that the actual experience of labor is not scary is a subjective statement that may not reflect the reality for many women. Labor can be intense, painful, and unpredictable, and minimizing this reality can lead to a lack of preparation or a sense of failure if the experience is difficult. Nurses should avoid imposing their own interpretations of the experience on the patient. Instead, the focus should remain on providing realistic expectations and supporting the patient's unique journey.
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