a woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor which finding indicates that preterm labor i
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1. A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which finding indicates that preterm labor is occurring?

Correct answer: D

Rationale: The correct answer is D. Cervical changes such as effacement and dilation to 2 cm are strong indicators of imminent preterm labor. These changes, combined with regular contractions, can signify labor at any gestation. Estriol can be detected in maternal plasma as early as 9 weeks of gestation. Levels of salivary estriol have been linked to preterm birth. Irregular, mild contractions occurring every 12 to 15 minutes without cervical change are generally not concerning. While the presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation may predict preterm labor, its predictive value is limited (20%-40%). Therefore, cervical changes provide more reliable information regarding the risk of preterm labor.

2. Rh incompatibility occurs when an Rh-negative woman is carrying an Rh-positive fetus.

Correct answer: B

Rationale: Rh incompatibility occurs when an Rh-negative woman is carrying an Rh-positive fetus, not the other way around. Therefore, the statement that an Rh-positive woman is carrying an Rh-negative fetus is incorrect. Rh incompatibility can lead to hemolytic disease of the newborn, where maternal antibodies attack the fetal red blood cells. Choice A is incorrect because the statement is false. Choice C is incorrect as Rh incompatibility has a clear cause and effect relationship. Choice D is incorrect as Rh incompatibility can occur, but it depends on the Rh status of the mother and fetus.

3. The _____ is the inner layer of the embryo from which the lungs and digestive system develop.

Correct answer: C

Rationale: The endoderm is the correct answer. It is the innermost layer of the embryo that gives rise to organs such as the lungs, digestive system, liver, and pancreas. The neural tube (Choice A) forms the brain and spinal cord, not the lungs or digestive system. Mesoderm (Choice B) develops into structures like muscles, bones, and circulatory system, not the lungs or digestive system. The umbilical cord (Choice D) serves as a connection between the embryo and the placenta, providing nutrients and oxygen, but it is not the layer from which lungs and digestive system develop.

4. Which of the following statements is true of menstruation?

Correct answer: B

Rationale: The correct statement regarding menstruation is that during this time, an unfertilized egg is discharged along with the shedding of the uterine lining. Choice A is incorrect because the endometrium is shed during menstruation. Choice C is incorrect as menstruation does not prevent a female from engaging in sexual activity with her partner. Choice D is incorrect as a fertilized egg does not undergo mitosis during menstruation but rather implants in the uterine lining for further development.

5. A client in labor requests nonpharmacological pain management. Which of the following nursing actions promotes client comfort?

Correct answer: A

Rationale: Assisting the client into a squatting position promotes comfort during labor. This position can help relieve pain by utilizing gravity, allowing the pelvic outlet to widen, and potentially facilitating the progress of labor. Lying in a supine position (Choice B) can hinder labor progression and increase discomfort. Applying fundal pressure (Choice C) can be inappropriate and may cause harm as it is not routinely recommended during labor. Encouraging the client to void every 6 hours (Choice D) is important for bladder management but does not directly address pain relief during labor.

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