A 40-year-old pregnant patient, currently hospitalized for preterm labor at 34 weeks’ gestation, is discussing potential delivery options with her provider based on the results of a fetal lung maturity test.

 Which prenatal test would the provider likely order to check for fetal lung maturity? 

Choice A rationale:

Bishop score: A tool used to assess the readiness of the cervix for labor induction. It evaluates factors such as cervical dilation, effacement, consistency, position, and station of the fetal presenting part.

Score ranges from 0 to 13: A higher score indicates a more favorable cervix for induction.

Score of 6 or less: Induction is less likely to be successful.

Score of 9 or higher: Induction is more likely to be successful.

Nurses understand: The importance of the Bishop score in predicting the likelihood of successful induction.

Nurses use this information: To counsel patients about the risks and benefits of induction, to prepare for induction, and to monitor progress during induction.

Choice B rationale:

Not always done for medical reasons: Induction can also be elective, meaning it is chosen for non-medical reasons, such as convenience or a desire to avoid a post-term pregnancy.

Examples of medical reasons:

Gestational hypertension or preeclampsia

Fetal growth restriction

Prolonged pregnancy

Chorioamnionitis

Oligohydramnios

Choice C rationale:

Trial of labor (TOL): A term used to describe a vaginal birth attempt after a previous cesarean delivery.

Not synonymous with induction of labor: TOL can occur spontaneously or be induced.

Choice D rationale:

Not always electively done at 37 weeks' gestation: The decision to induce labor at 37 weeks is made on a case-by-case basis.

Factors considered:

Maternal and fetal health

Bishop score

Patient preferences

Choice A rationale:

Attaching the IV line to the distal port is not a safe practice for oxytocin administration. This is because oxytocin is a high-alert medication that can have serious adverse effects if administered incorrectly. Attaching the IV line to the distal port increases the risk of the medication being infused too quickly, which can lead to uterine hyperstimulation, fetal distress, or even uterine rupture. The safest practice is to attach the IV line to the proximal port, which is closer to the patient's body and allows for slower infusion rates.

Choice B rationale:

Customizing the concentration of oxytocin is not a recommended practice. Oxytocin is available in a premixed solution of 10 units/mL, and this concentration should not be altered. Altering the concentration can lead to dosing errors and increase the risk of adverse effects.

Choice D rationale:

Titrating oxytocin to gravity is not a safe practice. Oxytocin should be administered using an infusion pump that can accurately control the infusion rate. Infusion pumps are necessary to ensure that the medication is administered at the correct dose and rate. Gravity-based infusions are less accurate and can lead to over- or under-infusion of the medication.

Choice C rationale:

Two RN verification is a safe practice for oxytocin administration. This practice involves having two registered nurses independently verify the medication, dose, and infusion rate before administration. This helps to prevent errors and ensure that the medication is administered safely.