A patient who is 33 weeks pregnant has been experiencing Braxton-Hicks contractions.Which information should the nurse include in responding to this patient?
This patient should begin to time the contractions.
This patient should document fetal activity daily.
This patient may be losing her mucus plug.
This patient’s contractions are normal at this time.
The Correct Answer is D
Braxton Hicks contractions are irregular, painless uterine contractions that occur throughout pregnancy, but are more noticeable in the third trimester. They do not indicate labor, but rather help in softening and ripening the cervix.
Choice A is wrong because the patient does not need to time the contractions unless they become regular, painful, and closer together, which are signs of true labor.
Choice B is wrong because documenting fetal activity daily is not related to Braxton Hicks contractions. Fetal activity is monitored to assess fetal well-being and detect any signs of fetal distress.
Choice C is wrong because losing the mucus plug is also not related to Braxton Hicks contractions. The mucus plug is a thick plug of mucus that seals the cervical canal during pregnancy and may be expelled before or during labor.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
This is because pregnancy-induced hypertension (PIH) can cause eclampsia, a condition characterized by seizures and coma.Eclampsia can occur during pregnancy, labor, or postpartum.
A nurse should monitor the client for signs of increased blood pressure, headache, blurred vision, epigastric pain, and hyperreflexia, which may indicate an impending convulsion.
Choice A is wrong because hemorrhage is not a common complication of PIH.
Hemorrhage may occur due to other causes such as uterine atony, lacerations, or retained placenta.
Choice B is wrong because urinary retention is not a common complication of PIH.
Urinary retention may occur due to other causes such as anesthesia, trauma, or infection.
Choice D is wrong because thrombophlebitis is not a common complication of PIH.
Thrombophlebitis is a condition where a blood clot forms in a vein and causes inflammation.
It may occur due to other risk factors such as immobility, dehydration, or injury.
Correct Answer is C
Explanation
The correct answer is choice C. Auscultate the fetal heart sounds.This is because spontaneous rupture of membranes (SROM) may be associated with fetal distress or cord prolapse, and the nurse should assess the fetal well-being as soon as possible.Fetal heart sounds can indicate the presence of fetal bradycardia, tachycardia, or decelerations, which may require immediate intervention.
Choice A is wrong because checking the specific gravity of the amniotic fluid is not a priority action after SROM.The specific gravity can help differentiate amniotic fluid from urine, but it is not as reliable as other methods such as nitrazine paper test or visual inspection.
Choice B is wrong because providing dry linens for the patient is a comfort measure, but not a priority action after SROM.The nurse should first ensure the safety of the fetus and the mother before attending to their comfort needs.
Choice D is wrong because notifying the health care provider is an important action after SROM, but not the first one.The nurse should gather relevant data such as fetal heart rate, maternal vital signs, and characteristics of the fluid before contacting the provider.
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