A patient in preterm labor at 30 weeks gestation receives two 12-mg doses of betamethasone intramuscularly.
The purpose of this pharmacological treatment is to:

Reduce maternal and fetal tachycardia associated with ritodrine administration.

Suppress uterine contractions.

Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

Stimulate fetal surfactant production and lung maturity.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Ritodrine is a beta-mimetic tocolytic that can cause maternal and fetal tachycardia. Betamethasone does not reduce this side effect. The primary purpose of betamethasone is to enhance fetal lung maturity. Tachycardia from ritodrine is a known side effect that is managed by monitoring and dosage adjustment, not by administering corticosteroids.

Choice B rationale

The purpose of betamethasone is not to suppress uterine contractions. Betamethasone is a corticosteroid that enhances the production of surfactant in the fetal lungs. Tocolytic medications like nifedipine or magnesium sulfate are used to suppress uterine contractions in preterm labor, allowing time for the betamethasone to take effect.

Choice C rationale

Magnesium sulfate therapy can cause respiratory depression as a side effect. Betamethasone does not maintain maternal respiratory effort or ventilation during this treatment. Calcium gluconate is the antidote for magnesium toxicity. The role of betamethasone is specific to fetal lung maturity, not maternal respiratory support during magnesium sulfate administration.

Choice D rationale

Betamethasone is a corticosteroid that stimulates the production and release of surfactant in the fetal lungs. Surfactant is a substance that reduces surface tension in the alveoli, preventing them from collapsing and improving gas exchange. Administering this medication to the mother improves fetal lung maturity and reduces the risk of respiratory distress syndrome in preterm infants.

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Correct Answer is D

Explanation

Choice A rationale

The term "flexed attitude" describes the posture of the fetus, not its position relative to the pelvic inlet. The engagement of the presenting part is a measure of station, which indicates how low the fetus has descended into the pelvis. A fetus can be flexed without being engaged.

Choice B rationale

A transverse lie describes the fetal axis being perpendicular to the maternal spine. The attitude refers to the relationship of the fetal parts to one another, such as the position of the head relative to the chest. A fetus can have a flexed attitude in a longitudinal or transverse lie.

Choice C rationale

Breech presentation is when the fetal buttocks or feet present first into the pelvis. Attitude describes the posture of the fetal limbs and head. While a fetus in breech presentation can have a flexed attitude, the terms describe different aspects of the fetus's position and posture.

Choice D rationale

The flexed attitude is the normal and most common fetal posture during labor. This position is characterized by the fetal chin resting on its chest, with the arms and legs crossed over the abdomen. This posture allows the smallest diameter of the fetal head to present to the pelvic inlet, facilitating descent.

A. A G2P1001 at 41 weeks gestation with a fetus in a transverse presentation. She has had one previous delivery, a spontaneous vaginal delivery at 42 weeks gestation. B. A 33-year-old G5P2204 at 37 weeks and two days gestation. Her previous deliveries were scheduled low-transverse cesarean sections. C. A 42-year-old G2P1001 at 38 weeks gestation carrying a fetus with an estimated fetal weight of 6 lbs 8 oz. Her first cesarean section was scheduled due to a breech position of the fetus. D. A 29-year-old G3P1011 at 39 weeks gestation. She has had one previous delivery, an emergent cesarean section with a classical vertical uterine incision.

Correct Answer is C

Explanation

Choice A rationale

This patient is not a good candidate due to the transverse fetal presentation. A fetus in a transverse lie cannot be delivered vaginally because the largest diameter of the fetus is positioned across the maternal pelvis. This presentation poses a significant risk of complications, including uterine rupture, necessitating a cesarean delivery.

Choice B rationale

This patient is not a good candidate because a history of multiple cesarean sections increases the risk of uterine rupture during a trial of labor. While a previous low-transverse uterine incision is generally considered a good candidate for TOLAC, the increased number of prior cesareans significantly raises the risk profile.

Choice C rationale

This patient is an ideal candidate for TOLAC. The previous cesarean section was for a non-recurring indication (breech presentation), not for a cephalo-pelvic disproportion. The estimated fetal weight is within a normal range, and the patient has a single previous low-transverse uterine incision, which is the safest type for a trial of labor.

Choice D rationale

This patient is not a good candidate for TOLAC because a previous classical vertical uterine incision has a significantly higher risk of uterine rupture during labor. This type of incision involves the contractile part of the uterus, and the scar is more likely to dehisce under the stress of uterine contractions, making TOLAC contraindicated.

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A patient in preterm labor at 30 weeks gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacological treatment is to:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient in active labor is told by the nurse-midwife that "the baby is in the flexed attitude.”. When she asks the nurse what that means, what should the nurse say?

Correct Answer is D

Explanation

Which of the following patients does the nurse recognize as a good candidate for a trial of labor after cesarean (TOLAC) and possible VBAC (vaginal birth after cesarean)?

Correct Answer is C

Explanation

Butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain) are the preferred opioid analgesics used during labor because these medications:

A patient in labor arrives at labor and delivery complaining of intense pain with contractions in her lower abdomen and perineal area. What does the nurse suspect?

A patient in labor has a fetal heart rate with late decelerations. Which of the following are appropriate intrauterine resuscitation measures? Select all that apply.

A pregnant patient's amniotic membranes rupture. What intervention would be the top priority?

The fetal heart rate is heard above the umbilicus and on the mother's left. The nurse concludes that the fetus is in which position?

The nurse is caring for a patient whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of:

Order: Pitocin 25 U IM now. Available: Pitocin 100 U in a 10 ml vial. How much will you draw up for one dose? (Provide the number only, no units of measurement.)

Tocolytic drugs are used in preterm labor to:

A patient in preterm labor at 30 weeks gestation receives two 12-mg doses of betamethasone intramuscularly.
The purpose of this pharmacological treatment is to: