A client tells the nurse that her contractions are occurring every 2 minutes and lasting 60 seconds for the last hour. What action should the nurse take first?
a. Assess cervical dilation and effacement.
b. Obtain a complete health history.
c. Perform Leopold's maneuvers.
d. Notify the physician.
A
These contractions are characteristic of the first stage of labor, so the nurse should assess cervical dilation and effacement first. While obtaining a complete health history and performing Leopold's maneuvers are important nursing interventions, establishing cervical dilation and effacement is a higher priority in this situation. The health care provider should be notified after the nurse assesses cervical dilation and effacement.
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