A nurse is assessing a woman in labor.
Which finding would the nurse identify as a cause for concern during a contraction?.
Blood pressure rise from 110/60 mm Hg to 120/74.
White blood cell count of 12,000 cells/mm.
Respiratory rate of 10 breaths/minute.
Heart rate increase from 76 bpm to 90 bpm.
The Correct Answer is C
Choice A rationale:
A slight increase in blood pressure during contractions is normal.
Choice B rationale:
A white blood cell count of 12,000 cells/mm is within the normal range.
Choice C rationale:
A respiratory rate of 10 breaths/minute is low and could indicate respiratory depression.
Choice D rationale:
A heart rate increase from 76 bpm to 90 bpm is within the normal range.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Implementing measures for a vaginal birth is a reasonable intervention as the baby is in a favorable position for a normal delivery.
Choice B rationale:
Continuous internal fetal monitoring is not necessary unless there are complications or high-risk factors present.
Choice C rationale:
Artificial rupture of the membranes can be done to induce or augment labor, but it’s not necessary in this case.
Choice D rationale:
Preparing for a cesarean birth is not necessary as the baby is in a favorable position for a vaginal birth.
Correct Answer is A
Explanation
Choice A rationale:
Physiologic anemia due to hemoglobin decrease does not cause dizziness when lying flat.
Choice B rationale:
A 50% increase in blood volume does not directly cause dizziness when lying flat.
Choice C rationale:
The gravid uterus can compress the vena cava when the woman lies flat, reducing blood flow to the heart and causing dizziness.
Choice D rationale:
Pressure of the presenting fetal part on the diaphragm can cause shortness of breath, but not dizziness.
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