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.)

Choice A rationale

While monitoring for contractions is important, the most critical assessment is the fetal heart rate. Contractions can occur during and after the procedure, but their presence alone is not as indicative of fetal well-being or distress as a change in the fetal heart rate. The contractions themselves are expected and a direct result of the manipulation of the uterus.

Choice B rationale

Checking the amniotic fluid volume is typically done via ultrasound prior to the procedure to ensure there's enough fluid for the fetus to be mobile. A version is contraindicated if there is insufficient fluid (oligohydramnios). However, this is a pre-procedure assessment, and a real-time assessment during and after the procedure is focused on the fetal response.

Choice C rationale

During a version, the fetus is manually repositioned, which can cause transient umbilical cord compression or placental abruption. Monitoring the fetal heart rate is paramount to detect signs of fetal distress, such as bradycardia or persistent decelerations, which would necessitate immediate cessation of the procedure. This assessment is the most direct indicator of fetal tolerance.

Choice D rationale

Monitoring for vaginal bleeding is important post-procedure to detect a placental abruption, which is a potential complication. However, changes in the fetal heart rate are often the earliest and most direct sign of fetal compromise and should be monitored continuously, both during and immediately after the procedure. Vaginal bleeding may be a later sign.

Choice A rationale

Fetal tachycardia is defined as a sustained baseline fetal heart rate above 160 beats per minute for ten minutes or longer. This elevated heart rate is an early sign of fetal hypoxemia, which can be caused by maternal fever, infection, dehydration, or certain medications. The increased heart rate is a compensatory mechanism to improve cardiac output.

Choice B rationale

A normal fetal baseline heart rate falls within the range of 110 to 160 beats per minute. This range reflects a healthy balance between the sympathetic and parasympathetic nervous systems regulating the fetal heart. A rate of 135 bpm is well within this normal range, indicating adequate fetal oxygenation and well-being.

Choice C rationale

Fetal bradycardia is defined as a sustained baseline fetal heart rate below 110 beats per minute for ten minutes or longer. This can be an ominous sign of severe fetal hypoxemia, maternal hypotension, or umbilical cord compression, all of which compromise oxygen delivery to the fetus and warrant immediate intervention.

Choice D rationale

Fetal hypoxia, or oxygen deprivation, is a state where the fetus is not receiving adequate oxygen supply. While both tachycardia and bradycardia can be indicators of hypoxia, a normal heart rate of 135 bpm does not suggest hypoxia. The absence of other non-reassuring signs further supports fetal well-being.