A nurse is teaching a client who is at 27 weeks of gestation and has pre-term labor about the signs and symptoms of true labor versus false labor.
Which of the following information should the nurse include in the teaching?
True labor contractions are irregular and subside with rest
False labor contractions are felt in the lower back and radiate to the abdomen
True labor contractions cause cervical dilation and effacement
False labor contractions increase in intensity with ambulation
The Correct Answer is C
True labor contractions cause cervical dilation and effacement.
This means that the cervix opens up and thins out to prepare for the baby’s passage through the birth canal.
Cervical changes can be measured by a pelvic exam.
Choice A is wrong because true labor contractions are regular and do not subside with rest. False labor contractions are irregular and may stop when you change position or activity level.
Choice B is wrong because false labor contractions are usually felt in the front of the abdomen, not in the lower back. True labor contractions may start in the back and radiate to the abdomen.
Choice D is wrong because false labor contractions do not increase in intensity with ambulation. True labor contractions may become stronger and closer together when you walk.
Normal ranges for cervical dilation and effacement vary depending on the stage of labor, but generally, full dilation is 10 cm and full effacement is 100%.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Monitor vital signs and neurological status frequently.
This is because intraventricular hemorrhage (IVH) is a common and serious complication of prematurity that can lead to hydrocephalus, cerebral palsy, and developmental delays.Monitoring vital signs and neurological status can help detect changes in intracranial pressure, bleeding, and infection.
Choice B is wrong because antibiotics are not indicated for IVH unless there is evidence of infection.
Choice C is wrong because elevating the head of the bed to 30 degrees can increase the risk of IVH by reducing cerebral perfusion pressure and causing venous congestion.
Choice D is wrong because supplemental oxygen is not recommended for IVH unless there is hypoxia or respiratory distress.Excessive oxygen can cause oxidative stress and vasoconstriction, which can worsen IVH.
Correct Answer is A
Explanation
A. Referral to community services for support.
Referral to community services for support is an important part of the discharge plan for a client in preterm labor.Community services can provide education, counseling, home visits, and other resources to help the client cope with preterm labor and prevent complications.
B. Encouragement to smoke in moderation.Statement is wrong because smoking is harmful for the unborn baby and can increase the risk of preterm labor.Smoking should be avoided completely during pregnancy and the client should be advised to quit or seek help to quit.
C. Instructions for heavy lifting and strenuous exercise.Statement is wrong because heavy lifting and strenuous exercise can trigger contractions and worsen preterm labor.The client should be instructed to rest as much as possible and avoid activities that may cause uterine irritation or bleeding.
D. Recommendation to avoid kangaroo care.Statement is wrong because kangaroo care, or skin-to-skin contact with the baby, is beneficial for both the mother and the baby after birth.Kangaroo care can help regulate the baby’s temperature, heart rate, breathing, and blood sugar levels, as well as promote bonding, breastfeeding, and infection prevention.The client should be encouraged to practice kangaroo care as soon as possible after delivery.
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