The fetal monitor demonstrates a pattern that reflects uteroplacental insufficiency.
What is the priority action by the labor nurse?

Move the client to the operating room for a cesarean.

Administer oxygen via face mask to the client.

Turn the client or ask the client to turn to their left side.

Increase the client's intravenous Lactated Ringer's.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Moving the client to the operating room for a cesarean section is an invasive, definitive intervention reserved for cases where conservative measures have failed to resolve non-reassuring fetal status or in the case of a fetal heart rate category III tracing. This is not the priority initial action for uteroplacental insufficiency, which can often be corrected by less invasive maneuvers to optimize fetal oxygenation. The initial steps are less aggressive.

Choice B rationale

Administering oxygen to the mother via a non-rebreather face mask at a high flow rate (e.g., 8-10 L/min) can mildly increase the partial pressure of oxygen in the maternal blood, thus potentially improving the amount of oxygen crossing the placenta to the fetus. While often a component of intrauterine resuscitation, optimizing the maternal-fetal blood flow via position change is typically the initial, most effective action.

Choice C rationale

Turning the client to the left or right lateral position (or asking the client to turn) is the priority action because it relieves compression of the vena cava and aorta by the gravid uterus. This action, known as intrauterine resuscitation, increases venous return to the heart, thus enhancing cardiac output, improving placental perfusion, and subsequently increasing oxygen delivery to the fetus, which is compromised in uteroplacental insufficiency.

Choice D rationale

Increasing the rate of a non-glucose-containing intravenous fluid such as Lactated Ringer's or normal saline (a bolus) is an intervention to improve maternal hydration and expand intravascular volume, which can help increase placental perfusion if hypotension is contributing to the insufficiency. However, volume expansion is generally secondary to the position change, which more directly addresses the mechanical compression causing decreased blood flow.

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Correct Answer is ["6"]

Explanation

Step 1 is: Convert oxytocin units to milliunits in the IV bag. 10 units× 1000 mU/unit = 10000 mU.

Step 2 is: Calculate the concentration of oxytocin in the IV bag in mU/mL. 10000 mU÷ 500 mL = 20 mU/mL.

Step 3 is: Calculate the milliliters per minute (mL/min) needed for the initial dose of 2 mU/min. 2 mU/min÷ 20 mU/mL = 0.1 mL/min.

Step 4 is: Convert the infusion rate from mL/min to mL/hr. 0.1 mL/min× 60 min/hr = 6 mL/hr. The final calculated answer is 6 mL/hr.

A. Administer Oxytocin. B. Administer 6 liters of Oxygen via face mask. C. Turn client on their left side and increase intravenous fluids. D. Raise the head of the bed and elevate the patient's legs.

Correct Answer is C

Explanation

Choice A rationale

Oxytocin is an uterotonic agent used to induce or augment labor or to prevent/control postpartum hemorrhage; it has no role in correcting hypotension caused by a neuraxial block, such as an epidural. The hypotension is due to sympathetic blockade causing peripheral vasodilation and subsequent venous pooling, decreasing venous return and cardiac output.

Choice B rationale

While oxygen administration may be part of the treatment for fetal distress secondary to maternal hypotension, administering it at 6 liters via face mask is not the priority action. The immediate priority is to restore maternal blood pressure to ensure adequate placental perfusion and oxygen delivery to the fetus by increasing preload.

Choice C rationale

Turning the client to the lateral position (left side preferred) displaces the uterus off the vena cava, alleviating aortocaval compression and improving venous return to the heart. Increasing intravenous fluids (a rapid bolus) expands the intravascular volume, which increases preload and helps counteract the vasodilation, thereby restoring blood pressure to the normal range of 90/60 to 140/90 mmHg.

Choice D rationale

Raising the head of the bed would worsen the hypotension because it promotes gravitational pooling of blood in the lower extremities, further decreasing venous return to the heart and exacerbating the drop in cardiac output. The preferred position is lateral (side-lying) or a slight Trendelenburg (feet higher than head) to promote blood return

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The fetal monitor demonstrates a pattern that reflects uteroplacental insufficiency. What is the priority action by the labor nurse?

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Naxlex Comprehensive Predictor Exams

Correct Answer is ["6"]

Explanation

Immediately following an epidural block, a client's blood pressure falls to 90/50. Which priority action would the nurse take.

Correct Answer is C

Explanation

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The fetal monitor demonstrates a pattern that reflects uteroplacental insufficiency.
What is the priority action by the labor nurse?