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.
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Related Questions
Correct Answer is D
Explanation
a. This is a sign of severe preeclampsia.
b. This is a sign of severe preeclampsia.
c. This is a sign of severe preeclampsia.
d. Deep tendon reflexes are not affected by preeclampsia, which is a hypertensive disorder of pregnancy characterized by high blood pressure, proteinuria, and edema.
Correct Answer is B
Explanation
a. A posterior presentation is when the fetus's back is toward the mother's back, and the fetal heart tones are usually heard on either side of the mother's abdomen.
b. A breech presentation is when the fetus's buttocks or feet are closest to the cervix. The fetal heart tones are usually heard above the umbilicus, at the midline, in a breech presentation.
c. A cephalic presentation is when the fetus's head is closest to the cervix, and the fetal heart tones are usually heard below the umbilicus, in either quadrant.
d. An oblique presentation is when the fetus's head or buttocks are angled toward one side of the pelvis, and the fetal heart tones are usually heard off-center, above or below the umbilicus.
e. A transverse presentation is when the fetus's spine is perpendicular to the mother's spine, and the fetal heart tones are usually heard on one side of the abdomen.
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