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NCLEX-RN · Question #127

A 26-year-old client is admitted to the labor, delivery, recovery, postpartum unit. The nurse completes her assessment and determines the client is in the first stage of labor. The nurse should…

The correct answer is C. Not to push with her contractions. (A) This nursing action may cause hyperventilation. (B) This nursing action could cause inferior vena cava syndrome. (C) The client is allowed to push only after complete dilation during the second stage of labor. The nurse needs to know the stages of labor. (D) If the client…

Physiological Integrity: Reduction of Risk Potential

Question

A 26-year-old client is admitted to the labor, delivery, recovery, postpartum unit. The nurse completes her assessment and determines the client is in the first stage of labor. The nurse should instruct her:

Options

  • ATo hold her breath during contractions
  • BTo be flat on her back
  • CNot to push with her contractions
  • DTo push before becoming fully dilated

How the community answered

(26 responses)
  • A
    4% (1)
  • C
    88% (23)
  • D
    8% (2)

Explanation

(A) This nursing action may cause hyperventilation. (B) This nursing action could cause inferior vena cava syndrome. (C) The client is allowed to push only after complete dilation during the second stage of labor. The nurse needs to know the stages of labor. (D) If the client pushes before dilation, it could cause cervical edema and/or edema to the fetal scalp; both of these could contribute to increased risk of complications.

Topics

#first stage labor#pushing instructions#labor management#cervical dilation

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