The client has been having contractions every 5 minutes for 7 hours.
Which factor would the nurse use to determine if this is true labor?
The cervix is effacing and dilating.
The membranes have ruptured.
This is the client’s second baby.
The contractions are more intense.
The Correct Answer is A
Choice A rationale
Effacement and dilation of the cervix are key indicators of true labor. Effacement refers to the thinning of the cervix, and dilation is the opening. True labor leads to progressive changes in the cervix.
Choice B rationale
Rupture of membranes can occur before, during, or after true labor. While it can be associated with labor, it alone does not confirm true labor as cervical changes do.
Choice C rationale
The number of pregnancies (parity) does not determine true labor. True labor is characterized by progressive cervical changes, not by the client's obstetric history.
Choice D rationale
The intensity of contractions alone does not confirm true labor. True labor is marked by regular, progressively stronger contractions leading to cervical effacement and dilation.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Terbutaline is a beta-agonist used to relax uterine muscles and delay preterm labor, not to augment labor in term pregnancies. It is not indicated for labor augmentation.
Choice B rationale
Betamethasone is a corticosteroid given to enhance fetal lung maturity in preterm pregnancies. It is not used to augment labor in term pregnancies, as it does not stimulate uterine contractions.
Choice C rationale
Pitocin (oxytocin) is a synthetic form of the natural hormone oxytocin. It stimulates uterine contractions and is commonly used to induce or augment labor in term pregnancies.
Choice D rationale
Magnesium sulfate is used primarily to prevent seizures in women with preeclampsia and to provide neuroprotection to preterm infants. It does not help augment labor contractions.
Correct Answer is D
Explanation
Choice A rationale
Folic acid does not reduce the risk of preeclampsia. Instead, it is crucial for preventing neural tube defects in the developing fetus during early pregnancy.
Choice B rationale
While folic acid can improve overall nutrition, its primary importance during pregnancy is in preventing neural tube defects by aiding in proper neural development.
Choice C rationale
Folic acid does not prevent patent ductus arteriosus. It is specifically recommended to prevent neural tube defects like spina bifida by supporting proper neural tube closure.
Choice D rationale
Folic acid is essential for preventing neural tube defects such as spina bifida. It helps ensure the proper closure of the neural tube during early fetal development, reducing the risk of these defects.
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