A client in post-term labor is receiving oxytocin.

The health care provider orders the oxytocin infusion to infuse at 4 mU/min.

The oxytocin concentration available is 20 units in 1000 mL lactated ringers.

How many mL/hr will the infusion run? Record numerical answer only. Round to the nearest whole number.

Choice A rationale

Placental abruption is the premature detachment of the normally implanted placenta from the uterine wall. The client's placenta is low-implanted, suggesting a placenta previa risk, not abruption. While the small for gestational age (SGA) fetus is associated with placental insufficiency, abruption is typically characterized by acute vaginal bleeding and pain, not exclusively by a low-implanted placenta on ultrasound.

Choice B rationale

Placenta accreta is an abnormal adherence of the placenta to the uterine wall, invading the myometrium. It is a major risk in clients with a history of previous cesarean births or uterine surgery. A low-implanted placenta (previa) on its own, without a history of uterine scarring, is not the primary indicator for accreta planning, which is focused on hemorrhage risk at delivery.

Choice C rationale

Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation. While a small for gestational age (SGA) fetus and placental issues can increase the risk of preterm labor, the specific finding of a low-implanted placenta on a 28-week ultrasound points more directly to the risk of placenta previa, which is the priority teaching topic.

Choice D rationale

Placenta previa is the implantation of the placenta over or near the internal cervical os. A low-implanted placenta revealed at 28 weeks' gestation is a strong indicator of an increased risk for previa as the pregnancy progresses. The associated fetal growth restriction (SGA) is often related to the placenta's suboptimal location and functionality, requiring teaching on bleeding precautions and warning signs.

Choice A rationale

A second-degree perineal laceration involves the vaginal mucosa, perineal skin, and the perineal muscles, but not the anal sphincter. The proximity of the repair to the urethra and the potential for perineal edema and pain can inhibit the voiding reflex and cause urethral spasm, leading to temporary difficulty in spontaneously emptying the bladder post-delivery.

Choice B rationale

The onset of milk production (lactogenesis II) is primarily controlled by the rapid drop in progesterone levels following the expulsion of the placenta and subsequent increase in prolactin release. A second-degree perineal laceration and repair, which is a localized soft tissue injury, has no direct physiological impact on the endocrine cascade responsible for initiating lactation.

Choice C rationale

Maladaptive bonding is a complex psychological issue influenced by factors like maternal mental health, pain, fatigue, and social support. While a painful laceration can contribute to discomfort and stress, a second-degree tear itself is a physical injury and does not directly cause an abnormal bonding process, which is a behavioral and emotional phenomenon.

Choice D rationale

Posterior vaginal varicosities (enlarged veins) are caused by the increased venous pressure and blood volume associated with pregnancy, and potential pressure from the descending fetal head during labor. A second-degree perineal laceration and its repair are the result of the birthing process and do not cause pre-existing vascular conditions like varicosities.