The healthcare provider ordered 500 mL D5W with 10 units of oxytocin to begin at 2 mU/min and then increase by 1 mU/min every 30 minutes until regular uterine contractions begin.

The maximum dose is 30 mU/min. What is the infusion flow rate for the beginning infusion? Round to the nearest whole number.

Choice A rationale

Green-stained amniotic fluid in a fetus, especially one who is post-term (41 weeks), is highly suggestive of meconium staining. This occurs when the fetus passes its first stool (meconium) in utero. While the meconium is expelled, its presence in the amniotic fluid is often a sign of fetal stress or compromise, which can lead to complications such as meconium aspiration syndrome.

Choice B rationale

Although green or foul-smelling amniotic fluid can indicate intrauterine infection (chorioamnionitis), particularly if accompanied by maternal fever or uterine tenderness, meconium staining is a more common cause in a post-term pregnancy with a breech presentation. Chorioamnionitis involves ascending infection of the membranes and fluid, not solely the color change due to meconium.

Choice C rationale

Neural tube defects, like spina bifida or anencephaly, are congenital structural abnormalities resulting from incomplete closure of the embryonic neural tube. While they can sometimes be associated with oligohydramnios or specific markers, they do not typically cause the amniotic fluid to turn green. Green fluid is a sign of a physiological event, not an anatomical malformation.

Choice D rationale

Meconium passage in utero, resulting in green amniotic fluid, is frequently an indicator of fetal distress or compromise, often due to hypoxia (oxygen deprivation) or umbilical cord compression. The fetus may pass meconium secondary to vagal nerve stimulation from stress. Therefore, the nurse's finding immediately alerts the team that fetal well-being may be acutely threatened, necessitating close monitoring and potential intervention.

Choice A rationale: Monitoring contraction duration only once every hour is inadequate and inappropriate in the presence of variable decelerations on the fetal heart rate (FHR) tracing. Variable decelerations are abrupt drops in FHR, often caused by umbilical cord compression. The nursing priority is to act immediately to relieve the compression and improve fetal oxygenation, not to observe the uterus infrequently.

Choice B rationale: Discontinuing the oxytocin infusion is the most critical and immediate intervention for this tracing. Oxytocin increases both the frequency and intensity of contractions, which can worsen cord compression and reduce the fetus’s recovery time between contractions. Stopping the uterine stimulation is the fastest way to relieve stress on the fetus.

Choice C rationale: Slowing the oxytocin infusion is a reasonable intervention, but it is not the first step. Because the variable decelerations are recurrent and pronounced, with FHR dropping below 90 bpm, the immediate and most effective action is to discontinue the infusion entirely. This should then be followed by other intrauterine resuscitation measures, such as repositioning the client laterally.

Choice D rationale: Increasing the flow rate of the main IV fluid line (a bolus) is a common intervention during fetal distress, as it can improve maternal blood volume, placental perfusion, and fetal oxygenation. However, in this case, the primary issue is recurrent variable decelerations likely caused by cord compression worsened by contractions. Therefore, the oxytocin must be stopped first to prevent further stress on the fetus.