Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
14. A client, who is gravida 4, para 2, is admitted to a labor and delivery unit. A nurse performs a vaginal examination and determines that the client's cervix is 6 cm dilated, 75% effaced, and a +1 station. Based on the nurse's assessment, in which stage of labor is this client?
. First phase, latent stage.
. First stage, active phase.
. First stage, transition phase.
. First phase, active stage.
Test-Taking Tip
Eliminate Answers 1 and 4 because there are four stages of labor and three phases in the first stage of labor. Eliminate Answer 3 because the woman is not yet in transition phase with 6 cm dilation.
Content Area: Maternity, Intrapartum; Integrated Process: Nursing Process, Analysis; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/System Specific Assessments
Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
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Answer 1 is incorrect because there is no first phase of labor, only the first stage of labor. Answer 2 is correct because there are four stages of labor and the first stage covers all phases of cervical dilation. This client is in the first stage, active phase, which is 4 to 8 cm dilation. Answer 3 is incorrect because first stage, transition phase would mean the client was 8 to 10 cm dilated. This client is 6 cm dilated, in the active phase of labor. Answer 4 is incorrect because there is no first phase of labor, only the first stage of labor.