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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The correct answer is choice A.
Choice A rationale:
An internal examination could disturb the placenta and cause profound bleeding, which is a life-threatening condition for both the mother and the fetus.
Choice B rationale:
While there is always a risk of introducing infection during an internal examination, this is not the primary reason to avoid it in a client with placenta previa.
Choice C rationale:
An internal examination could potentially initiate preterm labor, but this is not the primary concern with placenta previa.
Choice D rationale:
While there is a risk of rupture of the amniotic membranes during an internal examination, this is not the primary reason to avoid it in a client with placenta previa.
Correct Answer is C
Explanation
The correct answer is choice C.
Choice A rationale:
Notifying the provider is not necessary in this case as the findings are normal for a client who is 1 hour postpartum.
Choice B rationale:
Increasing the frequency of fundal massage is not necessary as the fundus is firm and at the umbilicus.
Choice C rationale:
The findings are normal for a client who is 1 hour postpartum. The nurse should document the findings and continue to monitor the client. Therefore, this choice is correct.
Choice D rationale:
Encouraging the client to empty her bladder is not necessary in this case as the fundus is midline.
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