Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth
Select one:
Bulging of the vulva
The membranes rupture during a contraction
The fetal head is felt at 0 station during vaginal examination
Bloody mucus discharge increases
The Correct Answer is A
a. Bulging of the vulva: This indicates that the fetal head is descending but does not necessarily mean the woman is almost ready to give birth. This indicates that the fetal head is crowning and putting pressure on the perineum, which means that delivery is imminent.
b. This indicates that the amniotic sac has ruptured but does not necessarily mean the woman is almost ready to give birth.
c. The fetal head at 0 station means that it is at the level of the maternal ischial spines, but it still needs to descend further to reach the perineum.
d. This indicates that the woman is in the early stages of labor but does not necessarily mean she is almost ready to give birth.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
a. This is a test for renal function, not fetal lung maturity.
b. This is a test for glucose control, not fetal lung maturity.
c. An L/S ratio of 2:1 or greater indicates that the fetal lungs have reached maturity.
d. This is a test of fetal well-being and does not indicate fetal lung maturity. This ratio indicates that the fetal lungs have enough surfactant to prevent alveolar collapse and respiratory distress syndrome.
Correct Answer is B
Explanation
a. While breast self-examination (BSE) can be done at any time, the best time is 5 to 7 days after menses ceases when the breasts are less likely to be tender or swollen.
b. This is the best time for BSE when the breasts are least likely to be tender or swollen.
c. This is not the best time for BSE.
d. This is not the best time for BSE.
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