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1. The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be: A. progressive uterine contractions with cervical change. Correct B. lightening. C. rupture of membranes. D. passage of the mucous plug (operc$17.99
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1. The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be: A. progressive uterine contractions with cervical change. Correct B. lightening. C. rupture of membranes. D. passage of the mucous plug (operc
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Course
Nursing
Institution
Nursing
1. The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be:
A. progressive uterine contractions with cervical change. Correct
B. lightening.
C. rupture of membranes.
D. passage of the mucous plug (operculum).
Regular, progressive uteri...
MATERNAL BOOK NCLEX QUESTIONS AND
ANSWERS.Approved
.
1. The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be:
A. progressive uterine contractions with cervical change. Correct
B. lightening.
C. rupture of membranes.
D. passage of the mucous plug (operculum).
Regular, progressive uterine contractions that increase in intensity and frequency are the
definitive sign of true labor along with cervical change. Lightening is a premonitory sign
indicating that the onset of labor is getting closer. Rupture of membranes usually occurs during
labor itself. Passage of the mucous plug is a premonitory sign indicating that the onset of labor
is getting closer
Awarded 1.0 points out of 1.0 possible points.
2. On completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6
cm, –1. What is a correct interpretation of the data?
A. The fetal presenting part is 1 cm above the ischial spines. Correct
B. Effacement is 4 cm from completion.
C. Dilation is 50% completed.
D. The fetus has achieved passage through the ischial spines.
, MATERNAL BOOK NCLEX QUESTIONS AND
ANSWERS.Approved
Station of –1 indicates that the fetal presenting part is above the ischial spines and has not yet
passed through the pelvic inlet. Progress of effacement is referred to by percentages, with 100%
, MATERNAL BOOK NCLEX QUESTIONS AND
ANSWERS.Approved
indicating full effacement and dilation by centimeters, with 10 cm indicating full dilation.
Progress of effacement is referred to by percentages, with 100% indicating full effacement and
dilation by centimeters, with 10 cm indicating full dilation. Passage through the ischial spines
with internal rotation would be indicated by a plus station such as +1.
Awarded 1.0 points out of 1.0 possible points.
3. In order to accurately assess the health of the mother accurately during labor, the nurse
should be aware that:
A. the woman’s blood pressure increases during contractions and falls back to
prelabor normal between contractions. Incorrect
B. use of the Valsalva maneuver is encouraged during the second stage of labor to
relieve fetal hypoxia.
C. having the woman point her toes reduces leg cramps.
D. the endogenous endorphins released during labor raise the woman’s pain
threshold and produce sedation. Correct
Blood pressure increases during contractions but remains somewhat elevated between them. Use of
the Valsalva maneuver is discouraged during second stage labor because of a number of
potentially unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps,
as can the process of labor itself.
D. In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of
the presenting part, decreases the mother’s perception of pain.
Awarded 0.0 points out of 1.0 possible points.
4. The nurse knows that the second stage of labor, the descent phase, has begun when:
A. the amniotic membranes rupture.
B. the cervix cannot be felt during a vaginal examination.
, MATERNAL BOOK NCLEX QUESTIONS AND
ANSWERS.Approved
C. the woman experiences a strong urge to bear down. Correct
D. the presenting part is below the ischial spines. Incorrect
Rupture of membranes has no significance in determining the stage of labor. The second stage
of labor begins with full cervical dilation. During the descent phase of the second stage of
labor, the woman may experience an increase in the urge to bear down. Many women may
have an urge to bear down when the presenting part is below the level of the ischial spines.
This can occur during the first stage of labor, as early as 5 cm of dilation.
Awarded 0.0 points out of 1.0 possible points.
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