The nurse is caring for a patient in labor. Which signs and symptoms would indicate the patient is progressing into the second stage of labor? Note: Credit will be given only for all correct choices and no incorrect choices
Select all that apply. 1. Bulging perineum
2. Increased bloody show
3. Spontaneous rupture of the membranes
4. Uncontrollable urge to push
5. Inability to breathe through contractions
1,2,4
Rationale 1: A bulging perineum indicates progression to the second stage of labor.
Rationale 2: Bloody show increases as a woman enters the second stage of labor.
Rationale 3: The amniotic sac can rupture at any time.
Rationale 4: When the cervix is fully dilated and the perineum is bulging, there is a strong urge to push.
Rationale 5: This symptom has no connection with going into the second stage of labor.
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