A nurse is assessing a client who is in active labor and notes that the presenting part is at 0 station. Which of the following is the correct interpretation of this clinical finding?
The lowermost portion of the fetus is at the level of the ischial spines.
The largest fetal diameter has passed through the pelvic outlet.
The posterior fontanel is palpable.
The fetal head is in the left occiput posterior positions
The Correct Answer is A
A. The lowermost portion of the fetus is at the level of the ischial spines.
A. The lowermost portion of the fetus being at the level of the ischial spines is the correct interpretation of 0 station. In the station system, when the presenting part is at the level of the ischial spines, it is referred to as 0 station.
B. The largest fetal diameter passing through the pelvic outlet is generally represented by the complete passage of the fetus through the birth canal. This is more indicative of full cervical dilation (10 cm) rather than a specific station.
C. The posterior fontanel being palpable is not directly related to the concept of station. Fontanel palpation is more associated with determining fetal head position.
D. The fetal head being in the left occiput posterior position is related to fetal position, not station. The station describes the descent of the presenting part in relation to the ischial spines.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
"You should replace the diaphragm every 5 years." This statement is inappropriate. Diaphragms typically need replacement more frequently than every 5 years. The lifespan of a diaphragm is usually shorter, and it may need to be replaced every 1 to 2 years, depending on the material and condition.
Choice B Reason:
"You should leave the diaphragm in place for at least 6 hours after intercourse." This statement is appropriate. Leaving the diaphragm in place for at least 6 hours after intercourse helps ensure its effectiveness in preventing pregnancy. Removing it too soon may increase the risk of sperm reaching the cervix.
Choice C Reason:
"You should use an oil-based product as a lubricant when inserting the diaphragm. "This statement is inappropriate. Oil-based lubricants can damage latex diaphragms. Water-based or silicone-based lubricants are recommended instead.
Choice D Reason:
"You should insert the diaphragm when your bladder is full." This statement is inappropriate. There is no specific need to insert the diaphragm when the bladder is full. However, emptying the bladder before insertion may make the process more comfortable for the client.
Correct Answer is D
Explanation
A. Brownish vaginal discharge may indicate the presence of old blood or mucus and is not necessarily a cause for concern in the absence of other signs or symptoms.
B. Contractions occurring every 4 to 5 minutes are within the normal frequency range during the first stage of labor.
C. Pink mucoid vaginal discharge, also known as the "bloody show," is a common occurrence in early labor and is not typically a cause for immediate concern.
D. Contractions lasting 100 seconds are excessively long and are a cause for concern.
Prolonged contractions can lead to decreased uterine blood flow, impacting fetal oxygenation. Such prolonged contractions should be assessed and addressed promptly.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today