Which documentation in the health record is most correct for the third stage of labor?

Begins with the time of full cervical dilation (dilatation) and ends with the delivery of the fetus.

Begins with the time of placental delivery and ends 48 hours later.

Begins with the time of placental delivery and ends when the health care provider is satisfied that there are no placental fragments.

Begins with the time of delivery of the fetus and ends with the time of the delivery of the placenta.

Answer and Explanation

The Correct Answer is D

The correct answer is choice D.

Choice A rationale:

This statement describes the second stage of labor, not the third. The second stage begins with full cervical dilation and ends with the delivery of the fetus.

Choice B rationale:

The third stage of labor does not end 48 hours after the delivery of the placenta. This choice is incorrect.

Choice C rationale:

While it’s important to ensure no placental fragments remain, the third stage of labor technically ends with the delivery of the placenta, not at this later point.

Choice D rationale:

This is the correct definition of the third stage of labor. It begins with the delivery of the fetus and ends with the delivery of the placenta.

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Correct Answer is C

Explanation

The correct answer is choice C.

Choice A rationale:

Notifying the provider is not necessary in this case as the findings are normal for a client who is 1 hour postpartum.

Choice B rationale:

Increasing the frequency of fundal massage is not necessary as the fundus is firm and at the umbilicus.

Choice C rationale:

The findings are normal for a client who is 1 hour postpartum. The nurse should document the findings and continue to monitor the client. Therefore, this choice is correct.

Choice D rationale:

Encouraging the client to empty her bladder is not necessary in this case as the fundus is midline.

A. "I should keep my baby's head covered.” B. "My baby's bassinet should be kept away from fans and air conditioning.” C. "My baby's temperature will be checked rectally every hour.” D. "I should place my baby on my stomach and cover her with a warm blanket.”

Correct Answer is C

Explanation

The correct answer is choice C.

Choice A rationale:

Keeping the baby’s head covered helps to prevent heat loss, as newborns lose a significant amount of heat through their heads.

Choice B rationale:

Keeping the baby’s bassinet away from fans and air conditioning helps to maintain a stable body temperature.

Choice C rationale:

Newborns’ temperatures are typically checked every 3 to 4 hours, not every hour, and are usually done axillary, not rectally.

Choice D rationale:

Placing the baby on the mother’s stomach and covering her with a warm blanket promotes skin-to-skin contact and helps to maintain the baby’s body temperature.

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Which documentation in the health record is most correct for the third stage of labor?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is 1 hr postpartum and observes a large amount of lochia rubra and several small clots on the client's perineal pad.The fundus is midline and firm at the umbilicus.Which of the following actions should the nurse take?.

Correct Answer is C

Explanation

A nurse is providing teaching about newborn care to a client who is 2 hr postpartum.Which of the following statements by the client indicates a need for further teaching?

Correct Answer is C

Explanation

A nurse is completing discharge instructions for a new mother and her 2-day-old newborn.The mother asks, "How will I know if my baby gets enough breast milk?" which of the following responses should the nurse make?.

A nurse is caring for a client on the second day postpartum.The client informs the nurse that she is voiding a large volume of urine frequently.Which factor should the nurse identify as a potential cause for urinary frequency?.

A nurse is discussing postpartum depression with a newly licensed nurse.Which of the following statements by the newly licensed nurse indicates an understanding of this condition?.

Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant.This is her 4th pregnancy.She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation.

A nurse is caring for a client who just delivered a newborn.Following the delivery, which nursing action should be done first to care for the newborn?

A nurse is assessing a postpartum woman.Which behavior would the nurse interpret as an indication that the woman is entering the taking-hold phase of the postpartum period?

In an effort to decrease complications for the infant right after birth, the nurse would expect to administer which medication for prophylaxis of potential eye conditions?.