when assessing a woman in the first stage of labor which clinical finding will alert the nurse that uterine contractions are effective

HESI LPN

HESI Maternal Newborn

1. When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective?

A. Dilation of the cervix.
B. Descent of the fetus to –2 station.
C. Rupture of the amniotic membranes.
D. Increase in bloody show.

Correct answer: A

Rationale: During the first stage of labor, effective uterine contractions lead to cervical dilation. Dilation of the cervix is a key indicator that uterine contractions are progressing labor. Descent of the fetus to -2 station (Choice B) is related to the fetal position in the pelvis and not a direct indicator of uterine contraction effectiveness. Rupture of the amniotic membranes (Choice C) signifies the rupture of the fluid-filled sac surrounding the fetus and does not directly reflect uterine contraction effectiveness. An increase in bloody show (Choice D) can be a sign of impending labor, but it is not a direct indicator of uterine contraction effectiveness.

2. Which of the following statements is true of mutations?

A. Mutations can only occur by chance.
B. Mutations produce sperm and ova cells.
C. Mutations occur through radiation or other environmental influences.
D. Mutations help adenine combine with guanine to form the single spiral structure of DNA.

Correct answer: C

Rationale: The correct answer is C. Mutations can occur due to environmental influences such as radiation, chemicals, or other external factors, leading to changes in the DNA sequence. Choice A is incorrect because mutations can also occur due to errors in DNA replication, not solely by chance. Choice B is incorrect as mutations affect the DNA sequence itself, not the production of specific cells. Choice D is incorrect because mutations involve changes in the DNA sequence and do not specifically involve the formation of the DNA structure.

3. Which FHR finding is the most concerning to the nurse providing care to a laboring client?

A. Accelerations with fetal movement.
B. Early decelerations.
C. Average FHR of 126 beats per minute.
D. Late decelerations.

Correct answer: D

Rationale: Late decelerations are caused by uteroplacental insufficiency, resulting in fetal hypoxemia. They are considered ominous if persistent, indicating compromised oxygen supply to the fetus. Accelerations with fetal movement (Choice A) are reassuring signs of fetal well-being. Early decelerations (Choice B) are typically benign, associated with head compression during contractions. An average FHR of 126 beats per minute (Choice C) falls within the normal range for fetal heart rate and is not concerning. Therefore, the most concerning FHR finding in a laboring client is late decelerations (Choice D).

4. A newborn with a respiratory rate of 40 breaths per minute at one minute after birth is demonstrating cyanosis of the hands and feet. What action should a nurse take?

A. Assess bowel sounds.
B. Continue to monitor.
C. Assist with intubation.
D. Rub the infant's back.

Correct answer: B

Rationale: Cyanosis of the hands and feet, known as acrocyanosis, is common in newborns shortly after birth and usually resolves on its own. It is not indicative of a need for immediate intervention. Therefore, the appropriate action is to continue monitoring the newborn's condition. Assessing bowel sounds (Choice A) is not relevant to the presenting issue of cyanosis and respiratory rate. Assisting with intubation (Choice C) is an invasive procedure that is not warranted based on the information provided. Rubbing the infant's back (Choice D) is not necessary for acrocyanosis and could potentially disturb the newborn.

5. Which of the following processes happen during mitosis?

A. Strands of deoxyribonucleic acid (DNA) break apart.
B. Adenine combines with its appropriate partner, cytosine.
C. Sperm and ova cells are created.
D. Twenty-three chromosomes are created.

Correct answer: A

Rationale: The correct process that happens during mitosis is the breaking apart, replication, and division of DNA strands into two new cells, each with the same number of chromosomes as the original cell. Choice B is incorrect because it describes base pairing in DNA, not a process specific to mitosis. Choice C is incorrect as the creation of sperm and ova cells is related to meiosis, not mitosis. Choice D is incorrect because chromosomes are not created during mitosis; they are replicated and divided equally between the daughter cells.