Aureissisting a nurse midwife in examining a client who is a primigravida at 42 weeks of gestation and states that she thinks she is in labor. Which of the following findings confirms that the client is in labor?
Fain just above the navel
Cervical dilation
Amniotic fluid in the vaginal vault
Contractions every 3 to 4 min
The Correct Answer is B
Choice A rationale: Pain above the navel is not a specific indicator of labor and may be unrelated to the onset of labor.
Choice B rationale: Cervical dilation is a definitive sign of labor. It indicates that the cervix is opening to allow the baby's passage through the birth canal.
Choice C rationale: The presence of amniotic fluid in the vaginal vault (rupture of membranes) could indicate that the client's water has broken, but it does not confirm active labor. Labor can begin before or after the rupture of membranes.
Choice D rationale: Regular contractions are a typical sign of labor, but their frequency alone does not confirm active labor. Other signs, such as cervical dilation and effacement, are necessary to confirm active labor.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale: Misoprostol is a prostaglandin analog and is contraindicated for use during labor at 32 weeks of gestation as it can lead to uterine hyperstimulation, which may pose a risk to the preterm fetus.
Choice B rationale: Folic acid is a vitamin supplement and is not contraindicated during labor. However, it is typically taken earlier in pregnancy to prevent neural tube defects.
Choice C rationale: Nifedipine is a calcium channel blocker that may be used to suppress preterm labor, and it is not contraindicated at 32 weeks of gestation.
Choice D rationale: Terbutaline is a beta-adrenergic agonist that may be used to relax the uterine smooth muscles and inhibit preterm labor. It is not contraindicated at 32 weeks of gestation.
Correct Answer is C
Explanation
Choice A rationale: This statement is correct. Burping the baby halfway through each feeding can help release air and prevent discomfort from gas build-up.
Choice B rationale: This statement is correct. It is essential to watch for signs of satiety in the baby, such as slowing down sucking, turning away from the bottle, or becoming relaxed.
Stopping the feeding when the baby is full helps prevent overfeeding.
Choice C rationale: This statement indicates a need for further teaching. The duration of feeding can vary for different babies, and it is not advisable to limit the feeding time to a specific duration like 10 to 15 minutes. Babies have different feeding patterns and may take longer or shorter periods to finish a feeding. It is essential to allow the baby to feed until they are full and satisfied.
Choice D rationale: This statement is correct. It is safe and appropriate to give formula to the baby at room temperature, or it can be warmed if the baby prefers it that way. However, never heat the formula in the microwave as it can create hot spots that may burn the baby's mouth. Instead, warm the formula by placing the bottle in a bowl of warm water. Always test the temperature on the inside of your wrist before feeding the baby to ensure it's not too hot.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today