A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take?

No action is necessary since a decrease in the woman's blood pressure is expected.

Decrease her intravenous (IV) rate to a keep vein-open rate.

Encourage her to empty her bladder.

Turn the woman to the left lateral position or place a pillow under her hip.

Answer and Explanation

The Correct Answer is D

A. No action is necessary since a decrease in the woman's blood pressure is expected. While a drop in blood pressure is a common side effect of a spinal block, a 20% decrease is significant and can compromise placental perfusion, leading to fetal distress. Intervention is necessary to restore circulation.

B. Decrease her intravenous (IV) rate to a keep vein-open rate. This is incorrect because IV fluids help counteract hypotension. Instead of decreasing the IV rate, the nurse may need to increase fluid administration to improve blood pressure and maintain perfusion.

C. Encourage her to empty her bladder. A full bladder can affect labor progression but does not directly cause or correct hypotension. The priority in this scenario is restoring blood pressure to ensure adequate fetal oxygenation.

D. Turn the woman to the left lateral position or place a pillow under her hip. This is the most appropriate intervention. A left lateral position or elevating her right hip helps relieve aortocaval compression, improving blood flow to the uterus and stabilizing blood pressure. Additional interventions, such as IV fluid boluses or vasopressors (e.g., ephedrine), may be needed if hypotension persists.

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Correct Answer is ["A","C"]

Explanation

A. Pitocin. Pitocin (oxytocin) is the primary medication used for labor induction. It stimulates uterine contractions to initiate or augment labor. It is given intravenously (IV) and carefully titrated to avoid complications like uterine tachysystole and fetal distress.

B. Methergine. Methergine (methylergonovine) is not used for labor induction. It is a uterotonic medication used postpartum to prevent or treat postpartum hemorrhage by causing sustained uterine contractions. It is contraindicated in pregnancy due to the risk of excessive uterine contractions and hypertension.

C. Misoprostol. Misoprostol (Cytotec) is a prostaglandin used for cervical ripening and labor induction. It is administered vaginally or orally to soften the cervix and stimulate contractions before starting Pitocin. It is commonly used in women with an unfavorable cervix.

D. Magnesium Sulfate. Magnesium sulfate is not used for labor induction. It is primarily used for seizure prevention in preeclampsia/eclampsia and to stop preterm labor (tocolysis). It actually relaxes the uterus, which is the opposite of what is needed for induction.

E. Betamethasone. Betamethasone is a corticosteroid used to accelerate fetal lung maturity in preterm labor (before 34 weeks). It has no role in labor induction.

A. Occiput anterior position. B. Breech presentation. C. Cervical dilation 5 cm. D. Station-4.

Correct Answer is ["B","D"]

Explanation

A. Occiput anterior position. The occiput anterior (OA) position is the ideal fetal position for vaginal delivery, where the baby’s head is well-engaged in the pelvis. This positioning reduces the risk of a prolapsed cord since the presenting part (the fetal head) effectively blocks the cord from slipping through.

B. Breech presentation. In a breech presentation, the buttocks or feet are the presenting part, leaving more space in the birth canal. This increases the risk of cord prolapse, especially if the feet or buttocks do not fully block the cervix, allowing the umbilical cord to slip past and become compressed.

C. Cervical dilation 5 cm. While cervical dilation is important in labor progression, it does not directly increase the risk of cord prolapse. The risk is more dependent on fetal position and station rather than the degree of cervical dilation.

D. Station -4. A high fetal station (e.g., -4) means the baby’s presenting part has not yet descended into the pelvis, leaving more room for the umbilical cord to slip through once the membranes rupture. A well-engaged fetus at station 0 or lower helps prevent prolapse by blocking the cervix.

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A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

To assist with an induction of labor which of these medications can be used? Select all that apply

Correct Answer is ["A","C"]

Explanation

A patient has just spontaneously ruptured her membranes. Which of the following factors makes her especially high risk for having a prolapsed cord? Select all that apply.

Correct Answer is ["B","D"]

Explanation

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