A nurse on a labor unit is admitting a client who reports painful contractions. The nurse determines that the contractions have a duration of 1 minute and a frequency of 3 minutes. The nurse obtains the following vital signs: fetal heart rate 130/min, maternal heart rate 128/min, and maternal blood pressure 92/54 mm Hg. Which of the following is the priority action for the nurse to take?

Correct Answer: B

Rationale: The correct answer is B: Position the client with one hip elevated. This is the priority action because the client's contractions are frequent and of significant duration, indicating active labor. Elevating one hip can help improve fetal oxygenation and blood flow during contractions. It can also help optimize fetal positioning for a smoother labor process. Choice A: Notifying the provider is important but not the priority at this moment. The nurse should first address immediate client needs. Choice C: Asking about pain medication is important, but managing the client's positioning for labor progress takes precedence. Choice D: Having the client void is a routine step in labor management but is not the priority action in this scenario.

Correct Answer: D

Rationale: The correct answer is D: Assist the client to the bathroom to void. A boggy and displaced fundus to the right in a postpartum client suggests a full bladder, which can displace the uterus. Voiding helps the uterus contract back to its normal position, reducing the risk of postpartum hemorrhage. Encouraging Kegel exercises (A) is not appropriate in this situation. Moving to the left lateral position (B) may provide temporary relief but does not address the underlying issue. Asking the client to rate her pain (C) is not relevant to the management of a displaced fundus.

Correct Answer: A

Rationale: The correct answer is A: Peanut butter. Phenylketonuria (PKU) is a metabolic disorder where the body can't process phenylalanine found in protein foods. Peanut butter is high in protein and contains phenylalanine, so it should be eliminated from the client's diet. Potatoes, apple juice, and broccoli are low in protein and do not contain high levels of phenylalanine, so they do not need to be eliminated. It is crucial for the client to avoid foods high in phenylalanine to prevent the buildup of toxic levels in the body, which can lead to serious health issues.

Correct Answer: B

Rationale: The correct answer is B: Weakened uterine contractions. Terbutaline is a tocolytic medication that inhibits uterine contractions. This helps prevent preterm labor. At 28 weeks of gestation, the nurse would expect terbutaline to weaken uterine contractions, rather than increase fetal heart rate (choice A), enhance fetal lung surfactant production (choice C), or lower maternal blood glucose levels (choice D). Weakening of uterine contractions is the expected therapeutic effect of terbutaline in this scenario to delay preterm labor.

Correct Answer: A

Rationale: The correct answer is A: Gradual lordosis. During the third trimester, the growing uterus shifts the center of gravity forward, leading to an increased lumbar curvature known as lordosis. This change helps maintain balance and support the extra weight. Increased abdominal muscle tone (B) is not an expected finding as abdominal muscles tend to stretch and weaken during pregnancy. Posterior neck flexion (C) is not a common physiologic change during the third trimester. Decreased mobility of pelvic joints (D) is incorrect as hormonal changes during pregnancy actually increase flexibility in the pelvic joints to prepare for childbirth.