A nurse in a prenatal clinic is caring for a client who is at 39 weeks of gestation and who asks about the signs that precede the onset of labor. Which of the following should the nurse identify as a sign that precedes labor?

A surge of energy

Urinary retention

Decreased vaginal discharge

Weight gain of 0.5 to 1.5 kg

Answer and Explanation

The Correct Answer is A

A.   A surge of energy: Some women experience a sudden burst of energy, often referred to as a "nesting" instinct, shortly before the onset of labor.
B.   Urinary retention: Urinary frequency and urgency are more common before labor, not urinary retention.
C.   Decreased vaginal discharge: Before labor, there might be an increase in vaginal discharge, often thick and pinkish, known as the "bloody show."
D.   Weight gain of 0.5 to 1.5 kg: Weight gain is not typically associated with the onset of labor.

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Correct Answer is D

Explanation

A.A client at 38 weeks of gestation with a cough and fever may have an infection, which is concerning, but it is not immediately life-threatening. The nurse should assess this client soon, but it is not the highest priority.

B.A client who has missed a period and reports vaginal spotting could be experiencing an early pregnancy complication, such as a miscarriage or ectopic pregnancy. This situation requires attention, but it is not as urgent as painless vaginal bleeding in the third trimester.

C.A client at 14 weeks of gestation with nausea and vomiting is likely experiencing common pregnancy symptoms. While these symptoms can be uncomfortable and require management, they are not typically urgent.

D.A client at 28 weeks of gestation with painless vaginal bleeding could be experiencing placenta previa or another serious condition that poses an immediate risk to both the mother and the fetus. This situation requires urgent assessment and intervention.

A. Increase the oxytocin infusion to 13 mu/min. B. Initiate a bolus of primary IV fluids. C. Place the client in a sidelying position. D. Apply oxygen at 10 L/min via a venturi mask. E. Perform a sterile vaginal examination (SVE).

Correct Answer is ["B","C","D"]

Explanation

The correct answer is B, C, and D.

Choice A: Increase the oxytocin infusion to 13 mu/min

Increasing the oxytocin infusion is not indicated in this scenario. Oxytocin is used to induce or augment labor, but if the fetal heart rate tracing is abnormal (Category 3), increasing oxytocin could exacerbate fetal distress. The priority is to stabilize the fetal condition before considering increasing oxytocin.

Choice B: Initiate a bolus of primary IV fluids

Initiating a bolus of primary IV fluids is appropriate. This action helps improve placental perfusion and maternal hydration, which can be beneficial in response to abnormal fetal heart rate tracings. Adequate hydration can enhance uteroplacental blood flow and improve fetal oxygenation.

Choice C: Place the client in a sidelying position

Placing the client in a sidelying position is recommended. This position can improve uteroplacental perfusion and fetal oxygenation, especially if there are signs of fetal distress. It helps to alleviate pressure on the inferior vena cava, enhancing blood flow to the placenta.

Choice D: Apply oxygen at 10 L/min via a venturi mask

Applying oxygen at 10 L/min via a venturi mask is indicated for improving fetal oxygenation in cases of abnormal fetal heart rate patterns. This intervention can help increase the oxygen available to the fetus, which is crucial in managing fetal distress.

Choice E: Perform a sterile vaginal examination (SVE)

Performing a sterile vaginal examination (SVE) is not indicated based on the provided assessment findings. While SVE is useful for assessing cervical dilation and labor progression, it is not a priority in this situation where the main concern is fetal well-being. Unnecessary SVEs can increase the risk of infection.

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A nurse in a prenatal clinic is caring for a client who is at 39 weeks of gestation and who asks about the signs that precede the onset of labor. Which of the following should the nurse identify as a sign that precedes labor?

Nursing Test Bank

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