A nurse is caring for a client who is in labor. Which of the following findings should prompt the nurse to reassess the client?

Progressive sacral discomfort during contractions

Intense contractions lasting 45 to 60 seconds

An urge to have a bowel movement during contractions

A sense of excitement and warm, flushed skin

Answer and Explanation

The Correct Answer is C

A. Discomfort in the lower back (sacral area) is common during labor, particularly during contractions. This is not an unusual finding that would require immediate reassessment.

B. Contractions lasting between 45 to 60 seconds are typical during the active phase of labor. This duration of contractions is expected as labor progresses, and does not require immediate reassessment.

C. This sensation can indicate that the fetus has descended into the birth canal and may be a sign that the client is entering the second stage of labor, or is close to delivery. This requires immediate reassessment by the nurse to check for full cervical dilation and fetal descent.

D. Emotional excitement and changes in skin temperature are typical responses during labor due to the physiological and emotional aspects of childbirth. This does not indicate the need for immediate reassessment.

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Correct Answer is A

Explanation

Lentils. Lentils have the highest fiber content per cup compared to the other options. One cup of cooked lentils provides approximately 15.6 grams of fiber. Oatmeal provides approximately 4 grams of fiber per cup, asparagus provides approximately 3.6 grams of fiber per cup, and cabbage provides approximately 2.6 grams of fiber per cup. Increasing dietary fiber is an effective way to manage constipation during pregnancy, as it can promote bowel regularity and prevent complications such as hemorrhoids. The nurse can provide additional education on other high-fiber food options, the importance of drinking adequate fluids, and the need to increase physical activity to help manage constipation.

A. Scant lochia B. Temperature 37.4° C (99.3° F) C. Uterine tenderness D. WBC Count 9,000/mm²

Correct Answer is C

Explanation

The correct answer is choice C: Uterine tenderness. Endometritis is an infection of the endometrial lining of the uterus. Uterine tenderness is a common finding in clients with endometritis.

Choice A, scant lochia, and choice D, WBC count 9,000/mm², are not typical findings in clients with endometritis. Choice B, temperature 37.4° C (99.3° F), is within the normal range and may not be indicative of endometritis.

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A nurse is caring for a client who is in labor. Which of the following findings should prompt the nurse to reassess the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing teaching about increasing dietary fiber to an antepartum client who reports constipation. Which of the following food selections has the highest fiber content per cup?

Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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