NCLEX® Question of the Day: 36-week gestation

Ready for today’s NCLEX-RN® question? Test your knowledge by what reproductive changes the nurse should anticipate with a patient who's 36 weeks pregnant.

The nurse in the obstetrical clinic is preparing to assess a patient who is at 36 weeks of gestation. Which reproductive change should the nurse anticipate?   

A. Asymmetrical breast tenderness

B. A fundal height measured at the umbilicus

C. Loss of the mucus plug

D. Increased production of thick white vaginal discharge

Scroll down for the correct answer!

The correct answer to today's NCLEX-RN® Question is...

D. Increased production of thick white vaginal discharge

Rationale: During pregnancy, the vagina increases the production of white, thick, and acidic secretions; therefore, this is an anticipated finding for this client.

Major Takeaway

During pregnancy, estrogen and progesterone promote breast development and milk production. Blood flow also increases to support the growth of breast tissue. Together, these changes can cause symptoms like tingling, fullness, and tenderness of both breasts. Other critical changes include leakage of colostrum and hypertrophy of Montgomery’s tubercles, which are sebaceous glands that lubricate the nipples. Uterine enlargement results from hyperplasia and hypertrophy of the uterine smooth muscle cells. By 20 weeks of gestation, the uterus, or top of the uterus, referred to as fundal height, reaches the level of the umbilicus. By 36 weeks, it rises to the xiphoid process, which, if measured from the symphysis pubis to the fundal height, should be 36 centimeters. At the same time, the number and size of blood vessels increase to provide nutritional support to the enlarging uterus. During the first two trimesters, the uterus is usually calm, with irregular, brief contractions, called Braxton-Hick's contractions or false labor pains. Once the third trimester starts, the uterus becomes active. These frequent uterine contractions can cause discomfort. The cervix increases in diameter and becomes hyperemic and more elastic. Endocervical glands start secreting a thick mucus that forms a plug and blocks the cervical canal. This plug prevents bacteria from entering the uterus, keeping the fetal membranes and fetus safe. Similarly, the vagina increases the production of white, thick, and acidic secretions.

Incorrect Answer Explanations

A. Asymmetrical breast tenderness

Rationale: During pregnancy, the client’s breasts can become tender due to increased blood flow and milk production. However, this anticipated tenderness is typically bilateral; therefore, this is not an anticipated finding and should be reported to the healthcare provider.

B. A fundal height measured at the umbilicus

Rationale: By 20 weeks of gestation, the uterus reaches the level of the umbilicus, and by 36 weeks, it rises to the xiphoid process. Therefore, this is not an anticipated finding for a client at 36 weeks gestation.

C. Loss of the mucus plug

Rationale: During pregnancy, the cervix increases in diameter and becomes hyperemic and more elastic. Endocervical glands start secreting a thick mucus that forms a plug and blocks the cervical canal; however, the mucus plug should be intact at 36 weeks gestation. Therefore, the loss of a mucus plug indicates the cervix is thinning and/or dilating and is not an anticipated finding for this client.