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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Follicle-stimulating hormone is important for the development of the ovarian follicles, but it’s not the most important for maintaining the female reproductive organs.
Choice B rationale:
Androgens are male hormones and are not the most important for developing and maintaining the female reproductive organs.
Choice C rationale:
Progesterone is important for maintaining the endometrium, but it’s not the most important.
Choice D rationale:
Estrogen is the most important hormone for developing and maintaining the female reproductive organs. It promotes the growth and development of the female secondary sexual characteristics and the growth of the endometrium.
Correct Answer is C
Explanation
Choice A rationale:
Contractions every 1 minute and cervical dilation of 9 cm are indicative of the transition phase of labor.
Choice B rationale:
Contractions every 2 1/2 minutes and cervical dilation of 8 cm are indicative of the active phase of labor.
Choice C rationale:
Contractions every 5 minutes and cervical dilation of 3 cm are indicative of the latent phase of labor.
Choice D rationale:
Contractions every 3 minutes and cervical dilation of 6 cm are indicative of the active phase of labor.
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