A nurse is providing care to a woman in labor.
The nurse determines that the client is in the active phase based on which assessment findings? Select all that apply.

Cervical effacement of 30%.

Strong desire to push.

Contractions every 90 seconds.

Cervical dilation of 6 cm.

Contractions every 2 to 3 minutes

Answer and Explanation

Correct Answer : D,E

Choice A rationale:

Cervical effacement of 30% is more indicative of the early phase of labor, not the active phase. In the active phase, effacement is usually 80-100%.

Choice B rationale:

A strong desire to push is usually associated with the transition phase of labor, not the active phase.

Choice C rationale:

Contractions every 90 seconds could be indicative of the active phase, but this can vary between individuals.

Choice D rationale:

Cervical dilation of 6 cm is indeed indicative of the active phase of labor, which is typically characterized by cervical dilation of 4-7 cm.

Choice E rationale:

Contractions every 2 to 3 minutes are common in the active phase of labor.

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Correct Answer is C

Explanation

Choice A rationale:

This is incorrect. Intercourse is unlikely to cause rupture of membranes.

Choice B rationale:

This is also incorrect. Intercourse is not likely to result in premature labor.

Choice C rationale:

This is correct. It is generally safe to have intercourse during an uneventful pregnancy.

Choice D rationale:

This is also correct. There are other ways to satisfy sexual needs if intercourse is not possible or desired.

A. Fundal height measurement. B. Fetal ultrasound. C. Urine for culture. D. Hemoglobin and hematocrit.

Correct Answer is A

Explanation

Choice A rationale:

Fundal height measurement is a common procedure during prenatal visits to monitor the baby’s growth.

Choice B rationale:

While ultrasounds are performed during pregnancy, they aren’t typically done at every prenatal visit.

Choice C rationale:

Urine cultures are important for detecting urinary tract infections, but they aren’t a routine part of every prenatal visit.

Choice D rationale:

Hemoglobin and hematocrit tests are done to check for anemia, but they aren’t typically performed at every visit.

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A nurse is providing care to a woman in labor. The nurse determines that the client is in the active phase based on which assessment findings? Select all that apply.

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Explanation

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Correct Answer is A

Explanation

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A nurse is providing care to a woman in labor.
The nurse determines that the client is in the active phase based on which assessment findings? Select all that apply.