While assessing a pregnant primigravida client, the nurse identifies a probable sign indicating the softening of the lower uterine segment.
Which of the following signs is the nurse likely to have observed?

Choice A rationale

Having the patient void is not the immediate priority. While it is important to ensure the bladder is not distended, which could interfere with labor progress, the vital signs suggest a more urgent concern.

Choice B rationale

Asking the patient if she needs pain medication is important for comfort measures during labor, but it is not the immediate priority. The nurse’s first responsibility is to ensure the safety of the mother and baby.

Choice C rationale

Turning the patient on her side and rechecking the blood pressure is the correct action. The maternal blood pressure is low, which could indicate supine hypotensive syndrome. This occurs when the gravid uterus compresses the inferior vena cava when the woman is supine, reducing venous return to the heart. Turning the woman on her side may relieve this pressure and improve blood pressure.

Choice D rationale

Notifying the healthcare provider of the findings is important, but it is not the first action the nurse should take. The nurse should first address the mother’s hypotension by turning her on her side.

Choice A rationale

Spina bifida is indeed an example of a neural tube defect. It occurs when the neural tube doesn’t close completely somewhere along the spine during fetal development. This is the correct answer.

Choice B rationale

Cerebral palsy is not a neural tube defect. It is a group of disorders that affect a person’s ability to move and maintain balance and posture.

Choice C rationale

Muscular dystrophy is not a neural tube defect. It is a group of diseases that cause progressive weakness and loss of muscle mass.

Choice D rationale

Hydrocephalus is not a neural tube defect. It is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain.