A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman’s fundus at which frequency? |
D R: During the first hour of the fourth stage of labor, the nurse would assess the woman’s fundus every 15 minutes and then every 30 minutes for the next hour. |
The nurse is preparing a young couple for the upcoming birth of their child, and the mother expresses concern for needing pain medications and the effects on the fetus. When counseling the couple about pain relief, the nurse would incorporate which information in the teaching about measures to help to decrease the requests for pain medication? |
B R: Continuous labor support involves offering a sustained presence to the laboring woman. A support person can assist and provide aid with acupressure, massage, music therapy, or therapeutic touch. Research has validated the value of continuous labor support versus intermittent support in terms of lower operative deliveries, cesarean births, and request for pain medication. |
The nursing instructor is teaching the students the basics of the labor and delivery process. The instructor determines the session is successful when the students correctly choose which action will best help to prevent infections in their clients? |
A R:The most important infection control technique in any health care setting is thoroughly washing hands on a routine basis. Keeping the area clean is secondary, but is also important. |
The nurse is providing preoperative care for a client who will undergo a cesarean section. The nurse should: |
A R: The nurse does not obtain the client’s consent, but should confirm that it has been obtained. Explaining the relative risks and benefits of each type of birth is beyond the nurse’s scope. Previous vaginal birth does not rule out a cesarean section. |
The nurse is reviewing the uterine contraction pattern and identifies the peak intensity, documenting this as which phase of the contraction? |
A R: The acme is the peak intensity of a contraction. The increment refers to the building up of the contraction. The decrement refers to the letting down of the contraction. Diastole refers to the relaxation phase of a contraction. |
A pregnant patient nearing her due date expresses anxiety over the labor and delivery process. Which outcome should the nurse select as appropriate for the patient during the delivery process? |
A. R: An outcome that indicates that the patient has less anxiety during labor and delivery would be the use of breathing techniques to control anxiety and pain during labor. Requesting pain medication, using sanitary napkins, and refusing complementary and alternative pain management techniques are not appropriate outcomes for labor and delivery. |
The client and her partner have prepared for a natural birth and bring a picture of a sunset over the ocean with them. The nurse predicts they will be using which techniuqe during labor? |
D R: Attention focusing is the use of an object or picture or image for the woman to reflect and focus on (internally or externally) during labor to distract her from the labor pain. Hypnosis is a psychological state. Water therapy involves the woman sitting in water to relax. Patterned breathing involves the woman controlling her breathing patterns during contractions and "breathing through" them to help control the pain. The attention focusing, patterned breathing, water therapy, and hypnosis are all variations of relaxation which may be used by the client during the birthing process. |
The client presents in the early stage of labor with mild contractions 7 to 9 minutes apart and blood pressure 130/80 mm Hg. The client changes from happy, excited, and confident to introverted and restless. Assessment reveals heart rate 100, blood pressure 137/85 mm Hg, and hyperventilation. EFM reveals no variability for almost 20 minutes, then evident variability with no late decelerations. Which action should the nurse prioritize? A. Help the client regain control of her breathing technique. |
A R: The primary focus is to regain her breathing to a normal rhythm; focus her on breathing and relaxation and relief from the hyperventilation. If there is not improvement, notify the RN. Putting the patient in the hands-and-knees position should be avoided until later in labor. |
A client in the latent phase of the first stage of labor is noted to be uncomfortable with intact membranes and mild contractions on assessment. The nurse should encourage the client to pursue which action? |
A R: To facilitate the first stage of labor, ambulation and movement will allow better fetal descent and help to speed the labor process. Bed rest will slow or stop the labor process. The client may use the bathroom as needed, but this does not affect labor rate. The client should remain mobile. |
A woman in early labor is using a variety of techniques to cope with her pain. When the nurse enters the room she notes that the woman is making light, circling movements with her fingertips across her abdomen. What technique is she using? |
D R: Effleurage is a form of touch that involves light circular fingertip movements on the abdomen and is a technique the woman can use in early labor. The theory is that light touch stimulates the nerve pathways to the brain and keeps them busy, thereby blocking the pain sensation. |
There has been much research done on pain and the perception of pain. What is the result of research done on levels of satisfaction with the control of labor pain? A. Women report higher levels of satisfaction when the primary care provider makes the decision on what type of pain control to use. |
B |
To assess the frequency of a woman’s labor contractions, the nurse would time: |
D |
The nurse is assessing a new client who presents in early labor. The nurse determines the fetus has an acceptable heart rate if found within which range? |
B R:The standard acceptable fetal heart rate baseline is the range of 110 to 160 beats per minute. Sustained heart rates above or below the norm are cause for concern. |
A woman’s husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse? |
A R: An epidural block, as the name implies, does not enter the spinal cord but only the epidural space outside the cord. |
Which intervention would be least effective in caring for a woman who is in the transition phase of labor? |
D R: Although ambulating is beneficial during early and possibly even active labor, the strong and frequent contractions experienced and the urge to bear down may make ambulating quite difficult. During transition, women should continue to breathe with contractions and focus on one contraction at a time. Providing one-to-one support at this time helps the woman cope with the events of this phase, as well as help her maintain a sense of control over the situation. |
A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage? |
D R: In early labor, the less medication use the better; allow use of nonpharmacologic management and control the pain with effleurage. Sitting in a warm pool of water is relaxing and may lessen the pain, but it does not control the pain. Sedatives are not indicated as they may slow the birthing process. Opioids should be limited as they too may slow the progression of labor. |
When developing a labor plan with the client, which outcome is the priority? A. The client will deliver the fetus vaginally. |
C R: Clients who have their pain managed report higher satisfaction with the birth experience. By working with the nurse in determining the labor plan, the health care provider, nurse and the client can work together to obtain a plan to manage labor pain. This puts the client in control of her care. The client nor the nurse is able to determine if a vaginal birth is feasible. It is rarely realistic to have a pain-free labor. Some discomfort is felt sometime within the labor process. It is strongly encouraged to have attended prenatal classes but not the priority. |
Which nursing action prevents a complication associated with the lithotomy position for the birth of the fetus? |
B R: Due to the lithotomy position, the nursing action of placing a wedge under the hips is correct to avoid supine hypotension. Rubbing the legs or massaging the back can relax the client between intense contractions but those actions do not prevent a complication. Providing a paper bag prevents hyperventilation typically caused by pattern breathing. |
Why should a woman be cautioned against taking acetylsalicylic acid (aspirin) to relieve pain in labor? |
B R: Acetylsalicylic acid (aspirin) is documented to cause interference with blood coagulation. |
If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first? A. Help the woman to sit up in a semi-Fowler’s position. |
D R: The most common cause of uteroplacental insufficiency is compression of the vena cava; turning the woman to her side removes the compression. |
A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman’s fundus at which frequency? |
Every 15 minutes R: During the first hour of the fourth stage of labor, the nurse would assess the woman’s fundus every 15 minutes and then every 30 minutes for the next hour. |
The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is: |
In the hypoxic fetus, the pH will fall below 7.2, which is indicative of fetal distress. |
A 19-year-old woman presents to the emergency department in the late stages of active labor. Assessment reveals she received no prenatal care. As part of her examination, a rapid HIV screen indicates she is HIV positive. To reduce the perinatal transmission to her infant, which intravenous medication would the nurse anticipate adminstering? |
B Zidovudine (ZDV) is recommended to reduce perinatal transmission of HIV (2mg/kg IV over an hour, and then a maintenance infusion of 1 mg/kg per hour until birth) or a single 200-mg oral dose of nevirapine at the onset of labor. Since this client presented in the late stages, zidovudine would be the better choice. Tenofovir and maraviroc are also HIV medications, but they are not the better choices for this scenario. |
The pain of labor is influenced by many factors. What is one of these factors? |
C R:The woman who enters labor with realistic expectations usually copes well and reports a more satisfying labor experience than does a woman who is not as well prepared. |
A nurse recommends to a client in labor to try concentrating intently on a photo of her family as a means of managing pain. The woman looks skeptical and asks, "How would that stop my pain?" Which explanation should the nurse give? |
B R: Concentrating intently on an object is another method of distraction, or another method of keeping sensory input from reaching the cortex of the brain. The other answers refer to other means of pain management. |
The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next? |
B R: The client should be administered oxygen by mask because the abnormal FHR pattern could be due to inadequate oxygen reserves in the fetus. Because the client is in preterm labor, it is not advisable to apply vibroacoustic stimulation, tactile stimulation, or fetal scalp stimulation. |
A client has been showing a gradual increase in FHR baseline with variables; however, after 5 hours of labor and several position changes by the client, the fetus no longer shows signs of hypoxia. The client’s cervix is almost completely effaced and dilated to 8 cm. Which action should the nurse prioritize if it appears the fetus has stopped descending? |
C R:Palpate to determine if the infant is engaged and what the presenting part of the infant is by the symphysis pubis; it is possible for infants to rotate and change position during labor. The nurse should assess the situation and act further if necessary, but until there is more information on the fetal position, the nurse should assume all is going well. |
General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks? |
C R: General anesthesia is not used frequently in obstetrics because of the risks involved. The pregnant woman is at higher risk for aspiration. It requires more skill to intubate a pregnant woman because of physiologic changes in the trachea and thorax. In addition, general anesthetic agents cross the placenta and can result in the birth of a severely depressed neonate who requires full resuscitation. |
If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor? |
D R: Lack of blood supply to the fetus because of poor placental filling prevents the fetal heart rate from recovering immediately following a contraction. |
The nurse is caring for a client who is diagnosed with a spinal headache. When completing a nursing assessment, which position would exacerbate the symptoms? |
C R:A spinal headache occurs when the client is in an upright position and is relieved when the client is laying down and still. The nurse is correct to avoid placing the client in the Fowler’s or upright position. The other positions may be attempted to assess client symptoms. |
In the labor and delivery unit, which is the best way to prevent the spread of infection? |
D R: Hand hygiene remains the number one way to prevent the spread of infection. It is appropriate to use sterile gloving for invasive procedures and limit vaginal examinations as much as possible. Providing clean gloving is also important when there is exposure to blood and body secretions. |
The nurse instructs the client about skin massage and the gate-control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods? |
A R:Gate control diverts the pain stimuli from the pain site by replacing with a comfort stimuli in a new location. |
During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor? |
B R:If vaginal bleeding is absent during admission assessment, the nurse should perform vaginal examination to assess the amount of cervical dilation. Hydration status is monitored as part of the physical examination. A urine specimen is obtained for urinalysis to obtain a baseline. Vital signs are monitored frequently throughout the maternal assessment. |
The nurse is admitting a primigravida client who has just presented to the unit in early labor. Which response should the nurse prioritize to assist the client in remaining calm and cooperative during birth? |
B R: Continuous labor support with a trained nurse or doula has been shown to be effective in increasing coping ability of laboring woman. To keep her calm, the nurse needs to explain all procedures and discuss all events to the mother. The nurse cannot know the final outcome and should be careful of making general statements indicating everything will be OK. It is the nurse’s responsibility to calm the client down and not wait for the health care provider. While calling the family may help, there is no guarantee and the nurse needs to work to calm the client down. |
When developing a labor plan with the client, which outcome is the priority? |
A R: Clients who have their pain managed report higher satisfaction with the birth experience. By working with the nurse in determining the labor plan, the health care provider, nurse and the client can work together to obtain a plan to manage labor pain. This puts the client in control of her care. The client nor the nurse is able to determine if a vaginal birth is feasible. It is rarely realistic to have a pain-free labor. Some discomfort is felt sometime within the labor process. It is strongly encouraged to have attended prenatal classes but not the priority. |
A patient in labor is prescribed transcutaneous electrical nerve stimulation (TENS) to help with pain relief during labor. How should the nurse explain the process of pain relief with this method? A. A machine is used to measure the patient’s ability to relax during contractions. |
B R: Transcutaneous electrical nerve stimulation (TENS) works to relieve pain by applying counterirritation to nociceptors. Low-intensity electrical stimulation blocks the afferent fibers, preventing pain from traveling to the spinal cord synapses from the uterus. Needles being inserted along meridians to release endorphins explain acupuncture. A machine to measure the patient’s ability to relax during contractions explains biofeedback. Small injections of saline to reduce back pain explain intracutaneous nerve stimulation. |
A primigravida client has just arrived in early labor and is showing signs of extreme anxiety over the birthing process. Why should the nurse prioritize helping the client relax? |
D R: Out of control anxiety can decrease the oxygen of the mother by increasing her respiratory rate and increasing the demand on her body, and can have a negative impact on the fetus by decreasing the amount of oxygen reaching the fetus. Encourage control of the anxiety. Anxiety will not negatively affect the action of the epidural or the need for anesthesia. Trust in the nurse is not determined by the amount of anxiety the client experiences. |
Which order by the health care provider would the nurse question if given in the active stage of labor? |
C R: A sedative, such as secobarital, is given in early labor to promote sleep or a hypertonic contraction pattern. This class of barbiturates can cause respiratory and central nervous system depression if given within 12 to 24 hours of birth. Ice chips may be provided to decrease symptoms of dry mouth. Providing client positioning with the use of pillows for support may allow the client to relax between contractions. For safety reasons, primarily during an intense contraction, the client needs assistance while out of bed. |
The nurse is assessing the read-out of the external fetal monitor and notes late decelerations. Which action should the nurse prioritize at this time? |
B R: Deceleration may be related to compression on the maternal abdominal aorta and inferior vena cava and repositioning the woman to either her right or left side will remove the pressure and allow the blood flow to resume. If this is not effective then the nurse would look for other potential causes such as an infusion of oxytocics. If this is unsuccessful the RN and health care provider needs to be notified immediately. The fetus is not getting enough oxygen and needs intervention. Palpating for bladder fullness would not be appropriate at this time. This is a serious situation developing and needs prompt intervention. |
How does a woman who feels in control of the situation during labor influence her pain? |
A R: Studies reveal that women who feel in control of their situation are apt to report less pain than those who feel they have no control. |
A woman refuses to have an epidural block because she does not want to have a spinal headache after birth. What would be the nurse’s best response? |
C R: Because epidural anesthesia does not enter the cerebral spinal fluid space, it is unlikely to cause a "spinal headache." |
Fetal heart rate monitoring reveals baseline tachycardia in the fetus. Which rate would be most likely? |
C R: A fetal heart rate of 164 beats per minute (bpm) indicates fetal tachycardia. The normal range of FHR is between 120 and 160 bpm. When the FHR is above 160 bpm, it should be considered as fetal tachycardia. Therefore, a FHR of 164 beats per minute is considered tachycardia. |
A gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture? |
C R: The infant is in the correct position, and the client has been in labor. Expectation would be for normal amniotic fluid presentation of clear to straw-colored fluid. If there is blood, then the uterus is bleeding and there is an extreme emergency. If the fluid is greenish, there is meconium in the fluid. Cloudy, white fluid may indicate an infection is present. |
A full-term neonate delivered an hour after the mother received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication? |
B R: Naloxone is the drug used for reversal of opioids’ adverse effects. If a narcotic is given too close to birth, the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered (respiratory depression, sleepiness) in the fetus for 2 to 3 hours after birth. Indomethacin is an analgesic and NSAID; ampicillin is an antibiotic; and epinephrine is a vasopressor. |
Immediately following an epidural block, a pregnant patient’s blood pressure suddenly falls to 90/50 mmHg. What action should the nurse take first? |
D R: To help prevent supine hypotension syndrome, place the pregnant patient on the left side after an epidural block. If hypotension should occur, the patient’s legs should be raised in addition to providing oxygen, intravenous fluids, and medication. The supine position encourages hypotension syndrome. Raising the head of the bed and deep breathing are not interventions to help with hypotension syndrome. |
During the assessment of a woman in labor, the nurse explains that certain landmarks are used to determine the progress of the birth. The nurse identifies which area as one of these landmarks? |
A R:Station is assessed in relation to the maternal ischial spines and the presenting fetal part. These spines are not sharp protrusions but rather blunted prominences at the midpelvis. The ischial spines serve as landmarks and have been designated as zero station. |
The nurse is assessing a woman at 37 weeks’ gestation who has presented with possible signs of labor. The nurse determines the membranes have ruptured based on which color of the Nitrazine paper? |
B R: If the fluid in the vaginal canal is amniotic fluid, the Nitrazine paper will turn a dark blue, the color of an alkaline fluid, and this is a positive Nitrazine test for rupture of membranes. |
Which assessment finding is most important as labor progresses? |
A R:It is most important that the uterus relaxes completely between contractions. If not, sufficient blood flow to the placenta and oxygen to the fetus may be interrupted. Also, uterine rupture can occur. It is appropriate for the client to remain in control of emotions. The nurse and support person provide emotional support as needed. There is no time frame for labor to be completed. It is normal for the pulse and respiratory rates to increase with the work of labor. |
A 39-week-gestation client presents to the labor and birth unit reporting abdominal pain. What should the nurse do first? |
A R:When a nurse first comes in contact with a pregnant client, it is important to first ascertain whether the woman is in true or false labor. Information regarding the number of pregnancies or history of drug allergy is not important criteria for admitting the client. The healthcare provider should be notified once the nurse knows the client’s current status. |
The nurse is preparing to assist with a pudendal block. The nurse predicts the client is at which point in the labor process? |
A R: Pudendal block is a local block in the perineal area and is used to numb for birth. Application before labor begins or while labor is in its early stages would be counterproductive, as the client would not have proper feeling and would have a harder time pushing. After birth it is pointless; the most painful part is over. |
A multigravida client admitted in active labor has progressed well and the client and fetus have remained in good condition. Which action should the nurse prioritize if the client suddenly shouts out, "The baby is coming!"? |
A R:The nurse needs to determine if birth is imminent by assessing the perineum and be prepared for birth. Once the nurse assesses the coming labor, the heart sounds, contraction rate, and contacting the primary care provider can all be done, if there is time. |
The nurse is caring for a client who has been in labor for the past 8 hours. The nurse determines that the client has transitioned into the second stage of labor based on which sign? |
B R:Second stage of labor is the pushing stage; this is typically identified by the woman’s urge to push or a feeling of needing to have a bowel movement. In the second stage the cervix can be 10 cm, dilated 100% and effaced. The station is usually 0 to +2. The emotional state may be altered due to pain and pressure. Contraction frequency is variable and not clearly indicative of a particular stage. The fetus can be at stage -1 for any length of time. |
In providing culturally competent care to a laboring woman, which is a priority? |
C R: Pain is a part of the labor process and management of the pain impacts the labor process itself. The nurse must effectively be able to assess the client’s pain level to be able to provide care. Individuals from different cultures express pain in different ways. All of the other options are important to understand but they do not directly relate to the client and birth process. |
A pregnant client is admitted to the labor and birth unit in the first stage of labor. A nurse reviews a pregnant client’s birth plan. Which response from the client would indicate to the nurse that further teaching is indicated? |
B R: The nurse should educate the client that she will be encouraged to get out of bed during labor. In the labor and birth process, many positions, ambulation, and water therapy may be used for comfort and positioning. All other answers are appropriate client responses. |
The community health nurse is conducting a presentation on labor and delivery. When illustrating the birth process, the nurse should point out zero station refers to which sign? |
C R:Zero station is when the fetus is engaged in the pelvis, or has dropped. This is an encouraging sign for the client. This sign is indicative that labor may be beginning, but there is no set time frame regarding when it will start. Labor has not started yet, and the fetus has not begun to move out of the uterus. |
The nurse is providing a report on a gravida 3 para 2 client. The nurse states that the client is fully effaced, 7 cm dilated, station +1, and contractions every 8 minutes. Which nursing action is most important at this time? |
B R: From the report, it is understood that the client’s labor is progressing. The most important nursing action at this time is to assess how the fetus is tolerating the labor process via the tocodynamometer. The nurse would also obtain vital signs and discuss pain management and contraction intensity. Depending upon the progression of the labor and how the client is feeling, the client may not ambulate in the hall. |
A multiparous woman at 39 weeks’ gestation arrives at the labor and delivery unit stating that she is in labor. Upon pelvic examination, the nurse documents a softening of the cervix and 3 cm dilation. Which nursing action is best? |
A R:To determine if the client is in true labor, the nurse is most correct to have her walk in the hall for approximately an hour. At that point, the client is rechecked to identify if labor has progressed. If labor has progressed, the client is admitted. Having the client rest in bed is not helpful to assist in labor progression. |
The nurse is caring for a client in labor and notes the woman’s cervix is approximately 1 cm in length. How should the nurse document this finding? |
D R: A cervix 1 cm in length is described as 50% effaced. A cervix that measures approximately 2 cm in length is described as 0% effaced. A cervix 0.5 cm in length would be described as 75% effaced. A cervix 0 cm in length would be described as 100% effaced. |
A woman in labor who is receiving an opioid for pain relief is to receive promethazine. The nurse determines that this drug is effective when the woman demonstrates which finding? |
A R: Promethazine is used in combination with an opioid to decrease nausea and vomiting and lessen anxiety. It may also be used to increase sedation. It does not affect the progress of labor. Benzodiazepines are used to calm a woman who is out of control, allowing her to relax enough to participate effectively during labor. |
The client is progressing into the second stage of labor and coping well with the natural birth method. Which instructions should the nurse prioritize at this point in the process? |
C R:The position is very important during labor. Allowing the woman to assume the most comfortable position will facilitate natural birth. The birthing ball allows the woman to move and adjust her position so that she can remain comfortable. The Valsalva maneuver may result in dangerous increases in blood pressure, so the nurse should be sure to instruct the mother to breathe as she pushes. The nurse should not intervene with who comes in or what family members are present unless she is asked, or unless the visitation is upsetting the mother. |
The client appears at the clinic stating that she is 8 months pregnant and has had no prenatal care due to a lack of health insurance. She states not feeling well with blurred vision and a terrible headache. The client’s blood pressure is 190/100 and edema is present in her lower extremities. Which diagnostic test will provide additional pertinent data? |
A R:Due to client symptoms suggesting preeclampsia, a urine dipstick test will screen for proteinuria. Proteinuria is commonly found in clients with preeclampsia. There are no other symptoms of an infection in the blood or a urinary tract infection requiring this diagnostic test. An ultrasound may be utilized at some point. |
Early in labor, a pregnant client asks why contractions hurt so much. Which answer should the nurse provide? |
A R: During contractions, blood vessels constrict, reducing the blood supply to uterine and cervical cells, resulting in anoxia to muscle fibers. This anoxia can cause pain in the same way blockage of the cardiac arteries causes the pain of a heart attack. Endorphins are naturally occurring opiate-like substances that reduce pain, not cause it. Distraction and mechanical irritation of nerve fibers are also methods of reducing pain, not causes of pain. |
The client presents in the early stage of labor with mild contractions 7 to 9 minutes apart and blood pressure 130/80 mm Hg. The client changes from happy, excited, and confident to introverted and restless. Assessment reveals heart rate 100, blood pressure 137/85 mm Hg, and hyperventilation. EFM reveals no variability for almost 20 minutes, then evident variability with no late decelerations. Which action should the nurse prioritize? |
C R:The primary focus is to regain her breathing to a normal rhythm; focus her on breathing and relaxation and relief from the hyperventilation. If there is not improvement, notify the RN. Putting the patient in the hands-and-knees position should be avoided until later in labor. |
Which client statement is anticipated after immediately receiving an intrathecal injection of pain medication? |
"I have no pain now." R: The advantage of intrathecal medication administration is that the medication is effective almost immediately. The medication is placed in the subarachnoid space. The other options still have the client feeling some discomfort. |
On examination, the nurse determines the client is at 50% effacement. This means: |
C R: Effacement refers to the length of the cervical canal. At 0%, the cervical canal is 2 cm long; at 50%, 1 cm long; and at 100%, the cervical canal is obliterated. |
Chapter 14 Prep-U OB (easy)
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