The nurse has received a report regarding her patient in labor. The woman's last vaginal examination was recorded as 2 cm, 80%, and +2. The nurse's interpretation of this assessment is that:
Select one:
The cervix is dilated 2 cm, it is effaced 80%, and the presenting part is 2 inches below the ischial spines.
The cervix is 2 cm dilated, it is effaced 80%, and the presenting part is 2 cm above the ischial spines.
The cervix is dilated 2 cm, it is effaced 80%, and the presenting part is 2 cm below the ischial spines.
The cervix is effaced 2 cm, it is dilated 80%, and the presenting part is 2 cm above the ischial spines.
The Correct Answer is C
a. This is an incorrect interpretation of the assessment.
b. This is an incorrect interpretation of the assessment.
c. This is the correct interpretation of the assessment indicating that the labor is progressing well and the baby is descending into the pelvis.
d. This is an incorrect interpretation of the assessment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
a. An abnormal odor of the amniotic fluid, such as a foul or fishy smell, may indicate infection and is a concern with ruptured membranes and an elevated temperature.
b. This may be necessary if the client has an infection or other complications, but it is not the first action to take.
c. This is not an appropriate action when the client has an elevated temperature and ruptured membranes.
d. Glucocorticoids may be administered to promote fetal lung maturity in preterm labor, but they are not appropriate in this situation.
Correct Answer is B
Explanation
a. Fertilization typically involves one sperm.
b. Sperm can live for up to 72 hours in the female reproductive tract, which is important for timing intercourse for conception.
c. Sperm typically reach the fallopian tubes within hours of ejaculation.
d. The ovum is typically fertilized within 24 hours of ovulation, not 72 hours.
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