The nurse is taking an advice call from a woman at 40 weeks' gestation.
The nurse instructs the patient to go to the hospital to be evaluated when the patient states which of the following?
"I passed the mucous plug.”.
"I have a trickle of fluid leaking from my vagina.”.
"I have had irregular contractions for the last hour.”.
"The baby has been moving.”. —
The Correct Answer is B
Choice A rationale
Passing the mucous plug (or bloody show) is a common sign of impending labor, often occurring days or weeks before labor onset, and does not in itself signify an emergency or mandate an immediate hospital visit for a 40 week patient. It is the loss of the cervical seal and indicates cervical change, but is not a definitive sign of active labor needing immediate evaluation.
Choice B rationale
A trickle of fluid leaking from the vagina in a term pregnancy could indicate premature rupture of membranes (PROM), where the amniotic sac has broken. This presents a risk of ascending intrauterine infection for the mother and fetus, and a risk of umbilical cord prolapse, necessitating immediate sterile speculum examination and fetal status evaluation at the hospital.
Choice C rationale
Irregular, short contractions that do not increase in frequency, duration, or intensity are characteristic of Braxton Hicks contractions (false labor), which are normal in the last weeks of pregnancy. The patient should be advised to monitor the contraction pattern for signs of true labor before presenting to the hospital.
Choice D rationale
Normal fetal movement is a sign of fetal well-being. At 40 weeks' gestation, the baby should still be actively moving. The nurse would only be concerned and instruct the patient to go to the hospital if she reported a decrease or cessation of fetal movement, indicating potential fetal distress or compromise.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Continued bloody show refers to the mucous plug mixed with a small amount of blood, which is a normal finding during labor as the cervix softens, effaces, and dilates. While the amount of bloody show is monitored, it is not the most immediate or critical concern compared to a pathway for bacterial ascent, especially in a GBS-positive client.
Choice B rationale
Cervical dilation of 4 cm indicates the client is in the active phase of the first stage of labor. Although the rate of dilation is important, a GBS-positive client at 4 cm is generally expected to progress, and this finding does not represent the highest risk compared to potential exposure from membrane rupture.
Choice C rationale
Contractions every 4 minutes indicate effective uterine activity for progression of labor, which is an expected physiological process. Monitoring contraction frequency and intensity is standard, but contractions themselves do not pose the greatest risk factor for a GBS-positive client compared to compromised integrity of the amniotic barrier.
Choice D rationale
Spontaneous rupture of membranes (SROM) 3 hours ago in a GBS-positive client significantly increases the risk of ascending infection, potentially leading to chorioamnionitis in the mother and neonatal sepsis. The GBS organism can colonize the birth canal, and once the barrier is broken for an extended period, the risk becomes acute, requiring prompt antibiotic prophylaxis.
Correct Answer is ["A","C","D"]
Explanation
Choice A rationale
Primary powers refer to the involuntary uterine contractions that occur during the first stage of labor. These contractions are responsible for two key processes: effacement, which is the shortening and thinning of the cervix, and dilation, which is the enlargement or widening of the cervical opening, preparing the birth canal.
Choice B rationale
Scarring of the cervix, known as cervical dystocia, is a significant complication that can severely impede or entirely prevent cervical dilation. The fibrotic tissue is less compliant and less responsive to the forces of uterine contractions, often leading to a protracted or arrested labor pattern, requiring intervention.
Choice C rationale
Pushing in the second stage of labor is optimally effective when it mimics the woman's natural urge to push, often described as the "ferguson reflex.”. Prolonged breath-holding (Valsalva maneuver) should be discouraged as it decreases maternal cardiac output and uterine-placental perfusion, potentially causing fetal distress.
Choice D rationale
In nulliparous (first-time pregnant) women, the cervix effaces (thins) completely before significant dilation begins. In multiparous women (subsequent pregnancies), effacement and dilation often occur concurrently, meaning they progress together throughout the first stage of labor, leading to faster total labor duration.
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