A nurse midwife is examining a client who is a primigravida at 42 weeks of gestation and states that she believes she is in labor.
Which of the following findings confirm to the nurse that the client is in labor?.
Brownish vaginal discharge.
Cervical dilation.
Amniotic fluid in the vaginal vault.
Report of pain above the umbilicus.
The Correct Answer is B
The correct answer is choice B.
Choice A rationale:
Brownish vaginal discharge can be a sign of labor but it is not definitive.
Choice B rationale:
Cervical dilation is a definitive sign that labor has started.
Choice C rationale:
Presence of amniotic fluid in the vaginal vault can indicate rupture of membranes but it does not confirm labor.
Choice D rationale:
Pain above the umbilicus is not a typical sign of labor.
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Related Questions
Correct Answer is D
Explanation
The correct answer is choice D.
Choice A rationale:
While antidepressants can be an effective treatment for postpartum depression, it is not the priority action. The priority is to ensure the safety of the mother and the baby.
Choice B rationale:
Reinforcing postpartum and newborn care discharge teaching is important, but it is not the priority action when a client is showing signs of postpartum depression.
Choice C rationale:
Assisting the family to identify prior use of positive coping skills in family crises can be helpful, but it is not the priority action when a client is showing signs of postpartum depression.
Choice D rationale:
The priority action when a client is showing signs of postpartum depression is to assess for suicidal ideation or thoughts of harming herself or her baby. This is because postpartum depression can lead to thoughts of self-harm or harm to the baby, and immediate intervention is necessary to ensure the safety of both the mother and the baby.
Correct Answer is A
Explanation
The correct answer is choice A. She did her perineal care independently.
Choice A rationale:
Taking the initiative for caring for her newborn independently while managing her own postpartum needs marks the taking-hold phase of infant bonding.
Choice B rationale:
Being eager to talk about her birth experience is more associated with the taking-in phase, not the taking-hold phase.
Choice C rationale:
Not asking for anything for pain all day is not a specific indicator of the taking-hold phase.
Choice D rationale:
Sitting and rocking her infant for long intervals is not a specific indicator of the taking-hold phase.
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