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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.

Answer and Explanation

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.

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Correct Answer is A

Explanation

Choice A rationale:

Cervical dilation is the major change occurring during the first stage of labor. This stage begins with the onset of labor and ends when the cervix is fully dilated.

Choice B rationale:

Fetal movement through the birth canal primarily occurs during the second stage of labor, not the first.

Choice C rationale:

Placental separation occurs during the third stage of labor, after the baby is born.

Choice D rationale:

Regular contractions do occur during the first stage of labor, but they are not the major change. The major change is cervical dilation.

A. Physiologic anemia due to hemoglobin decrease. B. A 50% increase in blood volume. C. Pressure of the gravid uterus on the vena cava. D. Pressure of the presenting fetal part on the diaphragm.

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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A nurse is assessing a woman in labor. Which finding would the nurse identify as a cause for concern during a contraction?.

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Naxlex Comprehensive Predictor Exams

A nurse is providing care to a pregnant woman in labor. The woman is in the first stage of labor. When describing this stage to the client, which event would the nurse identify as the major change occurring during this stage?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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A nurse is assessing a woman in labor.
Which finding would the nurse identify as a cause for concern during a contraction?.