Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
25. A nurse is monitoring the progress of a gravida 3, para 1 client in active labor. Which finding should be reported to a physician immediately?
Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
25. A nurse is monitoring the progress of a gravida 3, para 1 client in active labor. Which finding should be reported to a physician immediately?
. Moderate uterine contractions.
. Frequent urination.
. The presence of green-tinged amniotic fluid.
. The presence of scant bloody discharge.
Test-Taking Tip
The question is asking about what is not a normal part of active labor. Eliminate the options that are a part of normal labor: moderate contractions, frequent urination, and the presence of scant bloody discharge.
Content Area: Maternity, Intrapartum; Integrated Process: Nursing Process, Assessment; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Potential for Complications from Surgical Procedures and Health Alterations
Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
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Answer 1 is incorrect because moderate uterine contractions are a normal finding in active labor. Answer 2 is incorrect because frequent urination is a normal finding in active labor as a result of descent of the fetal head and decreased bladder capacity. Answer 3 is correct because the presence of green-tinged amniotic fluid is not a normal finding and needs to be reported to the physician immediately. Meconium staining can be indicative of fetal distress. Answer 4 is incorrect because presence of scant bloody discharge is a normal finding in active labor, called bloody show. It is an indicator of cervical progress.