The nurse is caring for a primigravida at 42 weeks' gestation with the following assessment data recorded in the patient's record: Cervix 2 cm dilated, Cervix 70

Choice A rationale

Requesting oxytocin to strengthen the contractions may be necessary if the contractions are indeed hypotonic (weak). However, with a high resting uterine tone (20-25 mm Hg; normal 5-15 mm Hg) and frequent, short contractions, this pattern suggests hypertonic uterine dysfunction, and oxytocin is contraindicated as it would worsen the uterine hyperstimulation and compromise fetal oxygenation.

Choice B rationale

Advising the client to simply be patient is inappropriate for this dysfunctional labor pattern. This pattern, characterized by short, frequent contractions with high resting tone, is ineffective and often causes significant pain and maternal fatigue without adequate cervical change. Interventions are required to address the uterine dysfunction.

Choice C rationale

This labor pattern is consistent with hypertonic uterine dysfunction, where the baseline uterine tone is elevated, preventing proper uterine muscle relaxation and adequate placental perfusion. The best intervention is to promote uterine rest and relaxation, often achieved through therapeutic rest (e.g., pain medication, sedation, or a change in environment) to allow the dysfunctional pattern to resolve.

Choice D rationale

Ambulation and physical activity are typically encouraged for hypotonic (weak, infrequent) labor to stimulate stronger contractions. In cases of hypertonic uterine dysfunction, movement may increase pain and does not promote the necessary uterine rest and relaxation to normalize the contractile pattern, potentially leading to further maternal exhaustion and fetal compromise.

Choice A rationale

Labetalol is a combined α and β-adrenergic blocker and is a preferred first-line agent for managing chronic or gestational hypertension in pregnancy. It acts by reducing systemic vascular resistance and mildly decreasing heart rate, effectively lowering blood pressure while minimizing risks to the developing fetus due to its established safety profile.

Choice B rationale

Digoxin is a cardiac glycoside primarily used to treat heart failure and control the ventricular rate in atrial fibrillation. While not a primary antihypertensive, it may be used in pregnant clients with pre-existing heart failure, which can complicate chronic hypertension, making its prescription possible in this client population.

Choice C rationale

Warfarin, an oral anticoagulant, is a teratogen classified as Pregnancy Category D, as it readily crosses the placenta and is associated with the Warfarin embryopathy (nasal hypoplasia, stippled epiphyses) in the first trimester, and fetal hemorrhage, making it generally contraindicated in pregnancy. Low molecular weight heparin is preferred.

Choice D rationale

Nitroglycerin, a potent vasodilator, is a medication that can be used intravenously to quickly manage severe, acute hypertensive crises in pregnant clients, although it's not a medication for chronic daily use. Its rapid action and control of blood pressure make it a potential, albeit specialized, option in obstetric emergencies.