A nurse is caring for a client who has been admitted to an antepartum unit. Click to highlight the findings that require follow-up. To deselect a finding, click on the finding again. History and Physical Day 1, 0900: 30-year-old client who is at 33 weeks of gestation, gravida 4 para 3. Maternal blood type is Rh positive. Last pregnancy resulted in a preterm spontaneous vaginal birth at 30 weeks of gestation. No known allergies. Nurses' Notes Day 1, 0900: Client reports lower back pain and pinkish vaginal discharge. Uterine contractions every 8 min, palpate strong, duration 30 seconds. FHR baseline is 145/min, minimal variability. Cervical examination indicates 2 cm, 50% effaced, 0 station. Membranes are intact. CBC and urinalysis collected and sent to laboratory.

Rationale for correct choices • Lower back pain and pinkish vaginal discharge: Pinkish vaginal discharge, often called “bloody show,” is a sign of cervical changes and indicates progression of labor. In combination with lower back pain, contractions and cervical effacement, it suggests that preterm labor may be underway and requires close monitoring. • Uterine contractions every 8 min, palpate strong, duration 30 seconds: Regular, strong contractions in the third trimester can signal preterm labor. Given the client’s history of preterm birth, this finding warrants close monitoring and possible interventions to halt labor progression or enhance fetal lung maturity. • FHR baseline 145/min, minimal variability: Minimal variability in the fetal heart rate can indicate fetal hypoxia or stress. Continuous monitoring and assessment of maternal-fetal status are necessary to identify potential complications and guide interventions. • Cervical examination 2 cm, 50% effaced: Cervical changes at 33 weeks indicate early cervical ripening, consistent with preterm labor. This finding requires follow-up to evaluate progression and implement appropriate interventions to prevent preterm birth. Rationale for incorrect choices • Membranes intact: Intact membranes indicate that preterm premature rupture of membranes has not occurred. This is reassuring and does not require immediate intervention, although ongoing assessment is needed.