A major responsibility of the nurse caring for a patient receiving oxytocin for labor induction is to
Monitor the patient's urinary output.
Monitor for tachysystole.
Monitor the patient's coping mechanisms for labor.
Monitor the IV site.
The Correct Answer is B
A. Monitor the patient's urinary output. While monitoring urinary output is important, it is not the primary concern when administering oxytocin for labor induction.
B. Monitor for tachysystole. Tachysystole (defined as more than 5 contractions in 10 minutes) is a potential complication of oxytocin administration. It can lead to fetal distress, so it is crucial to monitor for this condition.
C. Monitor the patient's coping mechanisms for labor. Monitoring coping mechanisms is important, but it is not the primary responsibility when administering oxytocin.
D. Monitor the IV site. While the IV site should be monitored for complications such as infiltration, it is not the primary concern with oxytocin administration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Determine the size of the fetus: Although Leopold’s maneuvers can give an idea of fetal size, the primary purpose is to assess the fetal position.
B. Determine the position of the fetus: Leopold's maneuvers are used to determine the position and presentation of the fetus in utero, aiding in delivery management.
C. Determine the size of the woman's pelvis: Pelvimetry, not Leopold’s maneuvers, is used to assess the size of the pelvis.
D. Determine the fundal height: Fundal height is measured separately to assess fetal growth, not with Leopold’s maneuvers.
Correct Answer is C
Explanation
A. Bloody show from the vagina: Bloody show is a normal sign during the second stage of labor, indicating that the cervix is dilating and the labor is progressing. It does not require immediate reporting.
B. Early decelerations in the FHR: Early decelerations are often a benign finding during labor, typically caused by head compression and do not usually indicate distress.
C. Uterine contraction lasting 2 minutes: A uterine contraction lasting 2 minutes is considered prolonged, and this can lead to decreased blood flow to the fetus, resulting in fetal distress. The provider should be notified.
D. Pelvic pressure with contractions: Pelvic pressure is a normal part of the second stage of labor as the fetus descends into the birth canal. This is an expected finding and does not require immediate reporting.
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