A nurse is teaching a new parent how to correctly use a car seat.
Which of the following statements by the parent 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

A shrill or high-pitched cry in a newborn can be a symptom of neurological irritability, which is often associated with hypoglycemia. Hypoglycemia in newborns can lead to central nervous system dysfunction due to insufficient glucose supply to the brain, manifesting as altered cry patterns.

Choice B rationale

Weak peripheral pulses can indicate poor cardiac output or peripheral vasoconstriction, which might be associated with conditions like congenital heart defects or hypovolemia. While significant hypoglycemia can impact cardiovascular function, weak pulses are not the primary or most specific indicator.

Choice C rationale

Yellowish skin, or jaundice, is caused by elevated bilirubin levels in the blood, often due to physiological immaturity of the liver or increased red blood cell breakdown. While jaundice can be a symptom of various newborn issues, it is not a direct or common sign of hypoglycemia.

Choice D rationale

Hypotonia, or decreased muscle tone, can be a symptom of various neurological issues, including severe hypoglycemia, but also other conditions like birth trauma, sepsis, or genetic disorders. While it can be present with hypoglycemia, a shrill cry is a more specific and earlier indicator.