A client at 39 weeks of gestation in a prenatal clinic asks about signs preceding labor. Which of the following should the nurse identify as a sign that precedes labor?

Correct Answer: B

Rationale: The correct answer is B: A surge of energy. This is a sign that precedes labor as the body may experience a burst of energy known as the "nesting instinct." This surge can occur as the body prepares for the upcoming physical demands of labor. A: Decreased vaginal discharge is not a sign of impending labor; in fact, there may be an increase in vaginal discharge as the body prepares for childbirth. C: Urinary retention is not a sign of impending labor and can be a symptom of other issues such as a urinary tract infection. D: Weight gain of 0.5 to 1.5 kg is not a specific sign of labor approaching; weight fluctuations during pregnancy are common and can vary based on various factors.

Correct Answer: D

Rationale: The correct answer is D. Ambulating a client with severe preeclampsia can be risky due to the potential for sudden worsening of symptoms and complications like seizures. It is important to prioritize rest and close monitoring in such cases. Assessing deep tendon reflexes every hour (A) is crucial as changes can indicate neurological involvement. Obtaining a daily weight (B) helps monitor fluid status. Continuous fetal monitoring (C) is necessary to assess the well-being of the fetus in cases of preeclampsia. In summary, ambulating the client with severe preeclampsia is the most concerning order as it may pose a significant risk to both the client and the fetus.

Correct Answer: D

Rationale: The correct answer is D, abruptio placentae. This condition is characterized by sudden onset of continuous abdominal pain and vaginal bleeding, common at 36 weeks gestation with pregnancy-induced hypertension. It occurs when the placenta prematurely separates from the uterine wall. Placenta previa (A) presents painless bleeding, prolapsed cord (B) involves cord presenting before the fetus, and incompetent cervix (C) leads to painless dilation of the cervix. Thus, abruptio placentae is the most likely complication in this scenario.

Correct Answer: C

Rationale: During a Leopold maneuver, if the healthcare professional determines that the fetus is in an RSA position, it means the fetal back is on the right side, and the small parts are on the left side, indicating a breech presentation. Therefore, the correct answer is C: Breech. The other choices are incorrect because: A: Vertex refers to the head-first position. B: Shoulder presentation would involve feeling the shoulder first during the maneuver. D: Mentum presentation would involve feeling the chin first, which is not the case in an RSA position.

Correct Answer: D

Rationale: The correct answer is D: Fetal position is persistent occiput posterior. This position, where the baby's head is facing the mother's abdomen instead of her back, can lead to severe backache and difficulty during labor due to increased pressure on the mother's spine. This malposition can impede the progress of labor and cause prolonged labor. Explanation of incorrect choices: A: Fetal attitude in general flexion is a normal position and not typically associated with severe backache. B: Fetal lie being longitudinal refers to the baby's position in relation to the mother's spine and is not directly related to backache. C: Maternal pelvis being gynecoid is a favorable shape for childbirth and is unlikely to cause severe backache during labor.