The nulliparous states, "I have been in labor for 4 hours and I am still only 2 cm dilated. Why is this happening? I feel like I should be ready to push by now." Which is the best response by the nurse?
A) "When your perineal body thins out, your cervix will begin to dilate much faster than it is now."
B) "The hormones that cause labor to begin are just getting to the levels that will change your cervix."
C) "What did you expect? You've only had contractions for a few hours. Labor takes time."
D) "Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress."
Answer: D
Cervical effacement must be nearly complete before cervical dilation takes place in primiparas. This is why the labor and birth of a first baby usually take much more time than for subsequent labor and births. The perineal body thinning primarily occurs during the second stage of labor; it is not expected early in labor. The reply "what did you expect" is not therapeutic. Although it is true that this client has only been in early labor for a short time, and it is true that labor for a nullipara averages 12-24 hours, the nurse must always be therapeutic in all communication. The hormones that cause labor contractions do not directly cause cervical change; the contractions cause the cervix to change.
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The nurse is preparing a client for a non–stress test (NST). Which interventions should the nurse plan to implement? (Select all that apply.)
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The nurse is assessing a client with an early onset of multiple sclerosis (MS). Which clinical manifestation does the nurse expect to see?
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