HESI - OB, Oxytocin
The nurse has received an order from the practitioner to begin labor augmentation with IV oxytocin on a patient at 39 weeks' gestation. The pharmacy notifies the nurse that no premixed bags are available and that the premixed solution will arrive on the unit in approximately 30 minutes. What is the most appropriate nursing action? A. Alert the practitioner that the oxytocin infusion is being held until the pharmacy delivers the solution to the unit. B. Obtain a vial of oxytocin and an isotonic solution and mix the oxytocin solution on the unit so the infusion can begin on time. C. Administer a dose of oxytocin 10 units IM in the left thigh to initiate the induction until the premixed solution is available. D. When the premixed oxytocin solution arrives from the pharmacy, give a bolus of it to initiate the induction.
A. Alert the practitioner that the oxytocin infusion is being held until the pharmacy delivers the solution to the unit. Rationale: The nurse should alert the practitioner that the infusion is not being started as ordered because premixed bags of oxytocin solution are not available. To maintain standardization in organizations and to prevent medication errors, oxytocin solutions should always come premixed from the pharmacy; the nurse should not attempt to mix the solution on the labor and delivery unit. Oxytocin is administered intramuscularly only in the postpartum period to prevent postpartum hemorrhage. Because of the potential for adverse cardiovascular reactions, such as hypotension and tachycardia, and the possible effect of water intoxication with an oxytocin overdose, a bolus is never used during induction and augmentation of labor. A bolus is used only after the birth of the newborn to prevent or treat postpartum hemorrhage.
When administering oxytocin for induction of labor with a low-dose or high-dose administration protocol, what is the usual frequency for incremental increases? A. Every 15 to 40 minutes B. Every 15 to 60 minutes C. Every 10 to 45 minutes D. Every 10 to 40 minutes
A. Every 15 to 40 minutes Rationale: The appropriate frequency for incremental increases is every 15 to 40 minutes. A 10-minute interval between increases is too short and could result in tachysystole. Waiting for 60 minutes between increases is not necessary unless indicated.
A patient has been given oxytocin at 5 milliunits/min for the past hour to augment labor. The patient's contractions are occurring every 1 to 3 minutes. The student nurse asks whether tachysystole is present. What should the nurse offer as the definition of tachysystole? A. More than 5 contractions in 10 minutes averaged over a 30-minute window B. Fewer than 6 contractions in 10 minutes averaged over a 30-minute window C. Contractions every 1 to 3 minutes D. Contractions lasting longer than 2 minutes
A. More than 5 contractions in 10 minutes averaged over a 30-minute window Rationale: Tachysystole is defined as more than 5 contractions in 10 minutes averaged over a 30- minute window. Fewer than 6 contractions in 10 minutes averaged over a 30-minute window does not constitute tachysystole. Contractions every 1 to 3 minutes would only be defined as tachysystole if there were more than 5 contractions in 10 minutes averaged over a 30-minute window. Tachysystole is not defined as contractions lasting longer than 2 minutes.
A patient is receiving oxytocin for induction of labor with an initial infusion rate of 2 milliunits/min and a titration rate of 2 milliunits/min every 30 minutes. The FHR tracing indicates a Category I pattern with uterine tachysystole. Despite implementation of interventions that include repositioning the patient to a lateral position and administering an IV fluid bolus, the tachysystole continues. A Category II FHR tracing is then observed. The nurse discontinues the oxytocin, which was infusing at 12 milliunits/min. After the infusion has been discontinued for 20 minutes, the tachysystole has resolved and the fetal monitor tracing indicates adequate fetal oxygenation. At which rate should the nurse restart the oxytocin infusion? A. 12 milliunits/min B. 6 milliunits/min C. 2 milliunits/min D. 1 milliunit/min
B. 6 milliunits/min Rationale: Commonly, an oxytocin infusion is resumed at no more than half of the previous infusion rate if the infusion has been discontinued for less than 20 to 30 minutes, so the nurse should restart the oxytocin infusion at 6 milliunits/min. If the oxytocin had been stopped for longer than 30 to 40 minutes, the infusion would be resumed at the initial dose ordered of 2 milliunits/min. The infusion would not be restarted at 12 milliunits/min because it has been discontinued for 20 minutes. Restarting the infusion rate at 1 milliunit/min is not correct.
The nurse removed the dinoprostone an hour ago from the cervix of a patient being induced for gestational diabetes at 39 weeks' gestation. The patient is having strong contractions lasting 60 to 90 seconds every 3 minutes. The nurse is preparing to start administration of oxytocin. What possible complication could occur? A. Rupture of membranes B. Tachysystole C. Increased pain D. Fetal bradycardia
B. Tachysystole Rationale: Tachysystole is the most likely complication because the patient is already contracting every 3 minutes and oxytocin will stimulate more contractions. Although the patient's membranes could rupture, this is not a possible complication of oxytocin administration. The patient's pain will likely increase; however, pain is a possible side effect rather than a complication of oxytocin administration. Although fetal bradycardia could occur as a result of tachysystole or uteroplacental insufficiency, it is not a direct complication of oxytocin administration.
A patient who is a gravida 5 para 4 at 38 weeks' gestation arrives at the labor and delivery unit in active labor. The nurse performs a sterile vaginal examination and determines that the patient's cervix is dilated to 8 cm. The patient has no IV access at the time of delivery. The nurse recognizes that the patient has an increased risk of postpartum hemorrhage because of multiparity. Which dose of oxytocin is most commonly prescribed to be administered intramuscularly after delivery of the placenta to prevent postpartum hemorrhage? A. 10 milliunits of oxytocin B. 20 milliunits of oxytocin C. 10 units of oxytocin D. 20 units of oxytocin
C. 10 units of oxytocin Rationale: The dose of oxytocin most commonly prescribed to be administered via intramuscular injection after delivery of the placenta in order to control postpartum bleeding is 10 units. Twenty units, 10 milliunits, and 20 milliunits are not correct doses for intramuscular injection of oxytocin.
The nurse is admitting a patient at 40 weeks' gestation for induction of labor. The nurse knows that in most cases, contraindications for labor induction are the same as the contraindications for vaginal birth. What contraindication would the nurse need to report to the practitioner? A. Group Beta Streptococcus positive B. Vertex presentation C. Active genital herpes D. Previous cesarean delivery with low transverse uterine incision
C. Active genital herpes Rationale: Active genital herpes is a contraindication for induction and vaginal birth because the fetus may become infected during delivery. Group Beta Streptococcus positive status is not a contraindication for induction and vaginal birth. A vertex presentation is desired for an induction and vaginal birth. A previous cesarean delivery with a low transverse uterine incision is not a contraindication for a vaginal birth.
A patient at 38 weeks' gestation with a history of preeclampsia is being induced. The patient received a dose of misoprostol 3 hours ago. The practitioner places an order for the nurse to start IV oxytocin now. What is the nurse's response? A. Start the oxytocin as soon as the pharmacy sends the premixed bag. B. Mix the oxytocin bag on the unit so there is no delay in initiating the oxytocin. C. Notify the practitioner of when the dose of misoprostol was given. D. Wait 2 hours to start the oxytocin.
C. Notify the practitioner of when the dose of misoprostol was given. Rationale: The nurse should notify the practitioner of when the dose of misoprostol was given because oxytocin should be initiated 4 to 6 hours, not 3 hours, after the patient has received prostaglandin E1 (e.g., misoprostol). Although having the oxytocin bag mixed by the pharmacy is important for patient safety, the oxytocin should not be initiated until 4 to 6 hours have elapsed after the dose of misoprostol was given. Failure to wait at least 4 hours before initiating oxytocin in this situation could lead to tachysystole. Waiting 2 additional hours before initiating oxytocin is not necessary if the misoprostol was given 3 hours ago.
A nurse is caring for a patient who has been receiving an oxytocin infusion for labor induction. The infusion was initiated approximately 8 hours ago and is currently infusing at 20 milliunits/min. While assessing the patient, the nurse observes a Category I FHR tracing with a contraction pattern of six contractions in 10 minutes averaged over 30 minutes. Which of these nursing interventions should come first? A. Further evaluate the fetal tracing. B. Decrease the oxytocin infusion. C. Place the patient in a lateral position. D. Administer oxygen at 10 L/min via nonrebreather mask.
C. Place the patient in a lateral position. Rationale: The primary intervention is to decrease uterine tachysystole by placing the patient in a lateral position and administering an IV fluid bolus. Interventions to decrease uterine tachysystole should not be delayed until negative fetal effects are noted because a delay in interventions may lead to poor fetal outcomes; therefore, the nurse should not wait to identify Category II or III FHR tracings. The patient should be placed in the lateral position, not in the supine position, which might cause supine hypotension. If uterine tachysystole does not resolve after 10 to 15 minutes after initiating a maternal position change and IV fluid bolus, the oxytocin infusion should be decreased, but this would not be the first intervention. If tachysystole does not resolve after an additional 10 minutes, the oxytocin infusion should be discontinued. For Category II or Category III tracings, administering oxygen at 10 L/min via a nonrebreather mask may be necessary. Oxygen administration is not necessary for Category I tracings.
The nurse admits a patient to the labor and delivery unit for induction of labor. The patient is at 37 weeks' gestation and has preeclampsia. The last ultrasound showed fetal growth restriction. The patient's current vital signs are blood pressure 167/101 mm Hg, pulse 96 bpm, respirations 20 breaths/min, and temperature 36.4°C (97.5°F). The patient denies feeling contractions or having pain. The practitioner has written orders to begin labor induction with oxytocin. What should the nurse do to establish maternal and fetal well-being upon admission? A. Obtain a specimen for a basic metabolic panel to determine the patient's electrolyte levels. B. Ask the practitioner to order tests to determine fetal lung maturity. C. Ask the practitioner to provide a valid reason for the induction of labor. D. Monitor the FHR and contraction patterns electronically for 20 to 30 minutes.
D. Monitor the FHR and contraction patterns electronically for 20 to 30 minutes. Rationale: The nurse needs to establish maternal and fetal well-being with an electronic tracing of the FHR and contraction pattern for 20 to 30 minutes upon admission; this information provides a baseline for evaluating the progression of labor and helps the nurse identify changes in status after the oxytocin infusion has been initiated. An electronic fetal monitor tracing of the FHR and uterine activity lasting 20 to 30 minutes generally provides an adequate baseline for evaluation. The nurse should remain aware of potential fetal lung immaturity, but the results of fetal lung maturity testing do not change the plan of care for delivery in this hypertensive patient. Gestational hypertension, or preeclampsia, is a medical indication for induction of labor in some patients, especially if fetal growth is impacted. The practitioner may request a basic or complete metabolic panel because of the patient's hypertensive status, but this testing is not required upon admission for the confirmation of maternal and fetal well-being.