A primigravida at 39 weeks’ gestation presents to the labor and delivery unit reporting intense, regular uterine contractions occurring every 2 minutes and lasting approximately 70 seconds. The client appears overwhelmed and irritable, is unable to focus on instructions, and repeatedly states, “I can’t do this anymore.” Vaginal examination reveals the cervix is 9 cm dilated, 100% effaced, with increasing fetal descent. Based on these assessment findings, which stage and phase of labor is the client most likely experiencing?

A nurse is caring for a client at 38 weeks gestation who is in active labor. The fetal heart rate tracing shows recurrent variable decelerations with each contraction. The amniotic fluid is clear, and the client is receiving IV oxytocin. Which nursing interventions are appropriate at this time? Select all that apply.

Immediately following placental delivery, a postpartum client becomes acutely dyspneic, hypotensive, and cyanotic. Oxygen saturation drops rapidly despite supplemental oxygen, and the client becomes unresponsive. Which condition should the nurse suspect first?

     A client, gravida 4 para 3, at 38 weeks gestation arrives in the emergency department with strong contractions that began 1 hour ago. The client is diaphoretic, grunting, and yelling loudly that she wants an epidural because she feels the need to push.  What priority action should the nurse take?

The nurse is caring for a client at 39 weeks gestation in active labor who is receiving an oxytocin infusion.  The nurse notes persistent late decelerations on the fetal monitor.  Which of the following actions should the nurse take?  Select all that apply.

A client in labor has reached 8 cm dilation, is fully effaced, and feels an urge to push.  The nurse observes thick, blood-tinged mucus during the vaginal examination.  What is the nurse’s best action?

A primigravida in early active labor (6 cm dilation) reports increasing contraction pain and anxiety. She is breathing rapidly, states that she feels overwhelmed, and verbalizes a desire to avoid pharmacologic pain management at this time. The fetal heart rate tracing is reassuring, and labor is progressing normally. Which nursing intervention is most appropriate to promote pain control and maternal coping at this time?

A pregnant client at 36 weeks’ gestation presents to the labor and delivery unit reporting a continuous trickle of fluid from the vagina for the past hour. The nurse performs a sterile speculum examination and applies vaginal fluid to Nitrazine paper, which immediately turns blue. The client denies recent urination but reports having intercourse earlier in the day. How should the nurse best interpret this finding?

A nulliparous client asks about being in “real” labor.  The nurse should teach that which signs are most indicative of true labor?  Select all that apply.

A supermarket introduced a self-checkout system to speed up the shopping process. Which type of cost is being reduced?