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","C","E"]
Explanation
a. Terbutaline is a beta-agonist that can be used to relax the uterus and delay delivery in preterm labor.
b. Oxytocin is a hormone that is used to induce labor and is not typically used in preterm labor.
c. Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that can be used to decrease uterine contractions in preterm labor.
d. Misoprostol is a prostaglandin E1 (PGE1) analog that is used for cervical ripening and is not typically used in preterm labor.
e. Magnesium sulfate is a tocolytic agent that can be used to relax the uterus and delay delivery in preterm labor.
Correct Answer is D
Explanation
a. Spontaneous rupture of the membranes (SROM) may or may not occur during labor and is not a reliable sign.
b. Engagement of the presentation is the descent of the fetal head or breech into the pelvis and can occur before labor begins.
c. Irregular contractions can occur during false labor (Braxton Hicks contractions) and are not a reliable sign of true labor.
d. Cervical effacement is the thinning and shortening of the cervix that occurs during labor. It is a sign of true labor, along with cervical dilation and regular contractions.

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