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. Diuresis B. Hypotension C. Increased risk for seizures D. Excessive uterine bleeding.

Correct Answer is D

Explanation

A. Diuresis. Increased urine output is a positive sign in a postpartum woman with preeclampsia, indicating that fluid shifts are occurring and the kidneys are functioning well. Magnesium sulfate does not cause fluid retention, and diuresis is not a major concern at this time.

B. Hypotension. While magnesium sulfate can cause vasodilation, leading to a mild decrease in blood pressure, severe hypotension is not the primary concern. The main hemodynamic concern postpartum is ensuring adequate uterine tone and preventing hemorrhage.

C. Increased risk for seizures. Magnesium sulfate is given to prevent eclampsia-related seizures, and its continued administration postpartum helps reduce seizure risk. The risk of seizures decreases after delivery, but stopping the infusion too early could increase the risk, making this a secondary rather than primary concern.

D. Excessive uterine bleeding. Magnesium sulfate relaxes smooth muscle, including the uterus, which can lead to uterine atony and increased postpartum hemorrhage risk. This is a critical concern in the immediate postpartum period, as uterine atony can result in life-threatening blood loss requiring urgent intervention.

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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?

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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 woman with preeclampsia gave birth vaginally 1 hour ago. She is still receiving a magnesium sulfate infusion at 1 gm/hr. A major concern regarding the administration of magnesium sulfate at this time would be:

Correct Answer is D

Explanation

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