questions and 100% verified answers
2025/2026
A nurse is teaching a primigravida about how she can identify the onset of labor. What clinical indicator
of labor would necessitate the client to call her health care provider? - Answer Membrane rupture or
contractions are 5 to 8 minutes apart
At a prenatal visit a client who is at 36 weeks' gestation states that she is having uncomfortable irregular
contractions. What should the nurse recommend? - Answer Walk around until they subside
How does the nurse identify true labor as opposed to false labor? - Answer Cervical dilation is
progressive
A primigravida is admitted to the birthing unit in early labor. A pelvic examination reveals that her cervix
is 100% effaced and 3 cm dilated. The fetal head is at + 1 station. In what area of the client's pelvis is the
fetus occiput? - Answer Below the ischial spines
A client in active phase of the first stage of labor begins to tremble, becomes very tense during
contractions and is quite irritable. She frequently states, "I cannot stand this a minute long." What does
this behavior indicate to the nurse caring for her? - Answer She is entering the transition phase of labor
A nurse assesses the frequency of a client's contractions by timing them from the beginning of the
contraction until when? - Answer To the beginning of the next contraction
A client is admitted to the birthing unit in active labor. What should the nurse expect after an
amniotomy is performed? - Answer Progressive dilation and effacement
A nurse is caring for a primigravida during labor. What does the nurse observe that indicates birth is
about to take place? - Answer Perineum begins to bulge with each contraction
A nurse is caring for a client in labor. What client response indicates that transition phase of labor
probably has begun? - Answer Perspires and has a flushed face
, A woman in active labor hears the health care provider tell the nurse that the fetal lie is longitudinal.
The mother asks the nurse what this means in relation to her labor and birth of the baby. How should
the nurse respond? - Answer A vaginal birth is possible
The fetus of client in labor is assessed to be at - 1 station. Where did the nurse locate the fetus's head? -
Answer Slightly above the ischial spines
A client in active labor is admitted to the birthing room. A vaginal examination reveals the cervix to be 7
cm dilated. What does the nurse expect the client to exhibit? - Answer Strong contractions with intervals
of several minutes
A nurse on the birthing unit is assessing a primigravida who states labor has begun. How does the nurse
know that this client is in true labor? - Answer Cervix is dilated
A few hours after being admitted in early labor, a primigravida perspires profusely and becomes restless,
flushed, and irritable. The client states that she is going to vomit. What phase of the first stage of labor
does the nurse suspect the client has entered? - Answer Transition
Why should a nurse teach pregnant women the importance of conserving the "spurt of energy" before
labor? - Answer Fatigue may influence the need for pain medication
What does a nurse consider the most significant influence on many clients' perception of pain when
interrupting findings from a pain assessment? - Answer Previous experience and cultural values
A primigravida who is at 40 weeks' gestation arrives at the birthing center with abdominal cramping and
a bloody show. Her membranes ruptured 30 minutes before arrival. A vaginal examination reveals 1 cm
dilation and the presenting part at - 1 station. After obtaining the fetal heart rate (FHR) and maternal
vital signs, what should the nurse do next? - Answer Provide the client with comfort measure used for
women in labor
How should a nurse direct care for a client in the transition phase of the first stage of labor? - Answer
Help the client to maintain control