A nurse is planning to administer misoprostol 50 mcg intravaginally for cervical ripening to a client who is at 40 weeks of gestation.

Available is misoprostol 200 mcg tablets. How many tablets should the nurse plan to administer?

Choice A rationale: Trendelenburg position, where the client is placed with the head lower than the feet, is not appropriate in this scenario. This position is typically used for procedures requiring pelvic exposure or in cases of air embolism. It does not optimize uteroplacental perfusion and may actually compromise maternal respiratory function in late pregnancy due to diaphragmatic pressure from the gravid uterus. Therefore, it is not the correct position following prostaglandin insertion.

Choice B rationale: Knee-chest position is used in obstetric emergencies such as umbilical cord prolapse to relieve pressure on the cord and improve fetal oxygenation. It is not indicated for cervical ripening or for optimizing uteroplacental perfusion. Maintaining this position would be uncomfortable and unnecessary for the client, and it does not aid in medication absorption. Thus, it is not the correct intervention in this context.

Choice C rationale: Lateral tilt, specifically left lateral or side-lying tilt, is the correct position. This position reduces compression of the inferior vena cava by the gravid uterus, thereby improving venous return, cardiac output, and uteroplacental perfusion. It also facilitates optimal absorption of the vaginal prostaglandin insert by keeping the medication in place. This is the evidence-based nursing intervention following prostaglandin administration for cervical ripening.

Choice D rationale: Lithotomy position is used primarily for vaginal examinations, procedures, or delivery. It is not appropriate for maintaining medication absorption or optimizing uteroplacental perfusion. Prolonged lithotomy positioning increases maternal discomfort and risk of venous stasis. Since the client is not undergoing delivery or a procedure requiring pelvic exposure, this position is not indicated after prostaglandin insertion.

Choice A rationale

The vacuum cup for an assisted birth is strategically placed on the fetal occiput, which is the posterior aspect of the fetal skull, not in front of the fetal ears. Proper placement over the posterior fontanelle promotes traction directly on the bone, minimizing the risk of fetal scalp injury and ensuring efficient rotation and descent of the fetal head during traction. Positioning near the ears is incorrect and dangerous.

Choice B rationale

During a vacuum-assisted birth, the client is actively encouraged to push effectively with each uterine contraction, as the vacuum traction is applied only during a contraction. Maternal pushing augments the force of the vacuum device and facilitates the fetal head's descent through the birth canal, maximizing the procedure's success while minimizing the duration and number of pulls required for delivery.

Choice C rationale

Continuous fetal monitoring is absolutely essential throughout a vacuum-assisted birth procedure. It allows the nurse and provider to immediately assess the fetal heart rate (FHR) response to the procedure, identify potential complications like bradycardia or non-reassuring FHR patterns, and guide the discontinuation of the vacuum if fetal compromise is detected.

Choice D rationale

Administering a fluid bolus to ensure a full bladder is contraindicated during labor and birth. An empty bladder is preferred for fetal descent and to prevent obstruction of the birth canal. Furthermore, a full bladder can potentially be damaged by the descending fetal head, making bladder emptying (catheterization) common prior to assisted delivery if necessary.