A charge nurse is teaching a newly licensed nurse about substance use disorders during pregnancy.
Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

The nurse should anticipate the provider will prescribe terbutaline and betamethasone.

Rationale for correct answers:
Terbutaline is a beta-2 adrenergic agonist that relaxes uterine smooth muscle by increasing intracellular cyclic AMP, reducing calcium influx, and thus inhibiting contractions. It is commonly used as a tocolytic to delay preterm labor, allowing time for fetal maturation. Betamethasone is a corticosteroid given to accelerate fetal lung maturity by stimulating surfactant production in the fetal lungs, which significantly reduces the risk of respiratory distress syndrome in neonates born between 24 and 34 weeks gestation. The normal fetal fibronectin level is ≤0.05 mcg/mL; a value above this, as in this client (0.09 mcg/mL), indicates increased risk of preterm birth, supporting the use of these medications.

Rationale for incorrect answers:
Oxytocin (Response 1) stimulates uterine contractions via oxytocin receptors, promoting labor induction or augmentation. Administering oxytocin before term or in preterm labor is contraindicated because it can worsen contractions, precipitating early delivery.

Betamethasone (Response 1) is not used to stop contractions but to promote fetal lung maturity. It does not act as a tocolytic; thus, it is not prescribed alone to delay labor.

Misoprostol (Response 1) is a prostaglandin E1 analog that promotes cervical ripening and uterine contractions, making it inappropriate in preterm labor management, where delaying labor is the goal.

Oxytocin (Response 2) serves no purpose in fetal lung maturation and instead promotes contractions; thus, it is contraindicated here.

Ondansetron (Response 2) is an antiemetic without effects on uterine activity or fetal lung maturity; its use is unrelated to preterm labor management.

Misoprostol (Response 2) induces labor and cervical changes and is contraindicated in preterm labor where prolonging pregnancy is desired.

Take-home points:

• Terbutaline delays preterm labor by relaxing uterine muscles, buying critical time for fetal development.
• Betamethasone accelerates fetal lung maturity by stimulating surfactant production, reducing neonatal respiratory complications.
• Oxytocin and misoprostol induce labor and are contraindicated in preterm labor management aiming to delay delivery.
• Fetal fibronectin levels above 0.05 mcg/mL indicate increased risk of preterm birth, guiding tocolytic and steroid therapy.

Choice A rationale

Encouraging the client to listen to music is an effective non-pharmacological pain management strategy in the latent phase of labor. Music provides a distraction, promotes relaxation, and can help to reduce the perception of pain by stimulating the release of endorphins, fostering a calmer environment and coping mechanism.

Choice B rationale

Instructing the client on biofeedback is a complex technique that requires training and practice for effective use. While it can be beneficial, the latent phase of labor may not be the ideal time to introduce and teach a new skill like biofeedback, as the client's focus may be limited by contractions and discomfort.

Choice C rationale

Administering fentanyl 100 mcg every hour via intermittent intravenous bolus is a pharmacological intervention typically used for more intense pain in active labor or for clients who desire or require stronger pain relief. The latent phase is characterized by milder, less frequent contractions, making non-pharmacological methods or lower-dose analgesics more appropriate.

Choice D rationale

Requesting a pudendal nerve block is usually reserved for the second stage of labor, specifically for episiotomy repair or forceps delivery, rather than for pain management during the latent phase. It provides regional anesthesia to the perineum and lower vagina, not generalized pain relief for uterine contractions in early labor.