A nurse assesses a client in labor and suspects dysfunctional labor (hypotonic uterine dysfunction). The woman's membranes have ruptured and fetopelvic disproportion is ruled out.
Which intervention would the nurse expect to include in the plan of care for this client?

Encouraging the woman to assume a hands-and-knees position.

Providing a comfortable environment with dim lighting.

Administering oxytocin.

Preparing the woman for an amniotomy.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Encouraging a hands-and-knees position may help rotate a malpositioned fetus or relieve back pain, but it does not directly address hypotonic uterine dysfunction, which is characterized by weak, ineffective contractions. While it can improve maternal comfort and potentially aid in fetal descent if malpositioning is a contributing factor to slow labor progress, it will not augment the strength or frequency of contractions necessary for cervical dilation.

Choice B rationale

Providing a comfortable environment with dim lighting can promote relaxation and potentially enhance the progress of labor in cases of hypertonic uterine dysfunction (uncoordinated, painful contractions). However, in hypotonic dysfunction, the issue is a lack of adequate uterine muscle activity. While comfort measures are always important, they do not directly stimulate stronger contractions.

Choice C rationale

Administering oxytocin is the primary medical intervention for hypotonic uterine dysfunction. Oxytocin is a synthetic hormone that stimulates uterine smooth muscle to contract more frequently and with greater intensity. This augmentation of uterine activity aims to establish an effective labor pattern, leading to cervical dilation and fetal descent when fetopelvic disproportion has been ruled out.

Choice D rationale

Preparing for an amniotomy (artificial rupture of membranes) might be considered to augment labor if the membranes are intact. However, the question states the membranes have already ruptured. Amniotomy can sometimes stimulate contractions by releasing prostaglandins, but it is not the first-line intervention for established hypotonic dysfunction after membrane rupture, and oxytocin is generally more effective in this situation.

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Correct Answer is B

Explanation

Choice A rationale

Accumulation of flatulence can cause abdominal discomfort after a cesarean birth, but it does not directly stimulate uterine contractions leading to afterpains. Afterpains are specifically related to the involution of the uterus, not gastrointestinal motility.

Choice B rationale

Breastfeeding stimulates the release of oxytocin from the posterior pituitary gland. Oxytocin is a powerful uterotonic hormone that causes the uterus to contract to its pre-pregnant size. These contractions are experienced as afterpains, especially in multiparous women whose uterine muscles may have less tone.

Choice C rationale

While some medications administered after birth can have side effects, severe cramps or afterpains are primarily a physiological response to uterine involution and the hormonal changes associated with breastfeeding, rather than a direct adverse effect of medication.

Choice D rationale

Healing of the abdominal incision after a C-section causes incisional pain, which is distinct from the cramping sensation of afterpains. Afterpains are specifically due to uterine contractions, not the healing process of the abdominal wall.

A. A client who has placenta previa. B. A client who has active genital herpes. C. A client who has a previous uterine incision due to multiple myomectomy. D. A client who has gestational hypertension.

Correct Answer is D

Explanation

Choice A rationale

Misoprostol is a prostaglandin analog that stimulates uterine contractions. It is contraindicated in clients with placenta previa due to the risk of severe hemorrhage from placental separation if contractions are induced.

Choice B rationale

Active genital herpes is a contraindication for vaginal delivery and therefore also a contraindication for induction of labor with Misoprostol, as it could potentially lead to vertical transmission of the herpes simplex virus to the newborn during passage through the birth canal.

Choice C rationale

A previous uterine incision due to multiple myomectomy can be a contraindication for labor induction with Misoprostol, depending on the type and location of the incisions. The increased risk of uterine rupture with strong contractions stimulated by Misoprostol is a significant concern in such cases.

Choice D rationale

Gestational hypertension, in the absence of other contraindications, can be an indication for induction of labor if the benefits of delivering the baby outweigh the risks of continuing the pregnancy. Misoprostol can be used cautiously in this situation to ripen the cervix and induce labor.

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A nurse assesses a client in labor and suspects dysfunctional labor (hypotonic uterine dysfunction). The woman's membranes have ruptured and fetopelvic disproportion is ruled out.Which intervention would the nurse expect to include in the plan of care for this client?

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Naxlex Comprehensive Predictor Exams

A multiparous client, 28 hours after a cesarean birth, who is breastfeeding, has severe cramps or afterpains.The nurse explains that these are caused by:

Correct Answer is B

Explanation

A nurse on the labor and delivery unit is assessing four clients.Which of the following clients is a candidate for an induction of labor with Misoprostol?

Correct Answer is D

Explanation

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A nurse assesses a client in labor and suspects dysfunctional labor (hypotonic uterine dysfunction). The woman's membranes have ruptured and fetopelvic disproportion is ruled out.
Which intervention would the nurse expect to include in the plan of care for this client?