A nurse midwife is examining a client who is 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?

Choice A rationale
Monitoring the fetal heart rate and movement is an important nursing intervention for this client. The client is at risk of fetal distress due to the high blood pressure, the preeclampsia, and the gestational diabetes. The fetal heart rate and movement can indicate the fetal well-being and oxygenation. The nurse should monitor the fetal heart rate continuously and perform a nonstress test or a biophysical profile as indicated.

Choice B rationale
Administering magnesium sulfate as prescribed is an important nursing intervention for this client. The client is at risk of seizures due to the severe preeclampsia. Magnesium sulfate is a medication that prevents and treats seizures in preeclamptic clients. The nurse should administer magnesium sulfate as prescribed and monitor the client's vital signs, reflexes, urine output, and magnesium level.

Choice C rationale
Encouraging the client to drink plenty of fluids is not an important nursing intervention for this client. The client is at risk of fluid overload due to the high blood pressure and the preeclampsia. Fluid overload can cause pulmonary edema, heart failure, and cerebral edema in the client. The nurse should restrict the client's fluid intake and monitor the client's weight, edema, and lung sounds.

Choice D rationale
Educating the client about the signs of preterm labor is not an important nursing intervention for this client. The client is at 34 weeks of gestation, which is close to the term pregnancy. The client is more likely to have a planned delivery or an induction of labor due to the high-risk conditions. The nurse should educate the client about the signs of preeclampsia, such as headache, blurred vision, epigastric pain, and decreased urine output.

Choice A rationale
Estrogen is not the hormone essential for maintaining pregnancy. Estrogen is a hormone that stimulates the growth and development of the female reproductive organs, the breasts, and the placenta. Estrogen also increases the blood flow and the uterine contractility during pregnancy. However, estrogen alone is not sufficient to sustain the pregnancy, as it needs to be balanced by progesterone.

Choice B rationale
Oxytocin is not the hormone essential for maintaining pregnancy. Oxytocin is a hormone that stimulates the contraction of the uterine and the mammary glands. Oxytocin plays a role in the initiation and the progression of labor, as well as in the milk ejection during breastfeeding. However, oxytocin is not involved in the maintenance of the pregnancy, as it can cause premature labor if released too early.

Choice C rationale
Human chorionic gonadotropin (hCG) is not the hormone essential for maintaining pregnancy. hCG is a hormone that is produced by the placenta and the embryo. hCG supports the corpus luteum, which is the structure that produces progesterone in the early pregnancy. hCG also prevents the immune system from rejecting the fetus, and stimulates the production of other hormones, such as estrogen and progesterone. However, hCG is not the main hormone that maintains the pregnancy, as its levels decline after the first trimester, when the placenta takes over the production of progesterone.

Choice D rationale
Progesterone is the hormone essential for maintaining pregnancy. Progesterone is a hormone that prepares the endometrium, which is the lining of the uterus, for the implantation of the fertilized egg. Progesterone also maintains the pregnancy by preventing the uterine contractions and the immune response against the fetus. Progesterone is produced by the corpus luteum in the early pregnancy, and by the placenta in the later pregnancy.