Maternity Nursing Q 125
A patient is in the second stage of labor. During this stage, how frequently should the nurse in charge assess her uterine contractions?
A. Every 5 minutes.
B. Every 15 minutes.
C. Every 30 minutes.
D. Every 60 minutes.
Correct Answer: B. Every 15 minutes
During the second stage of labor, the nurse should assess the strength, frequency, and duration of contraction every 15 minutes. If maternal or fetal problems are detected, more frequent monitoring is necessary.
Option A: Second stage of labor starts when cervical dilatation reaches 10 cm and ends when the baby is delivered. At this stage, the patient feels an uncontrollable urge to push. Monitoring every 5 minutes would be too frequent and inconvenient for the laboring mother.
Option C: After cervical dilation is complete, the fetus descends into the vaginal canal with or without maternal pushing efforts. The fetus passes through the birth canal via 7 movements known as the cardinal movements. These include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. These movements may occur in a few minutes, so 30 minutes might be too long to assess for contractions.
Option D: Monitoring hourly would be too long and the nurse might miss the important details of assessment.