Which of the following patients is an appropriate candidate for augmentation of labor with oxytocin? A G2P1 who presents with:
A fetus displaying signs of distress on the FHR monitor.
Placenta previa.
Active genital herpes lesions.
Hypertension of pregnancy or gestational hypertension.
The Correct Answer is D
Choice A rationale
A fetus displaying signs of distress, such as late decelerations or minimal variability on the FHR monitor, is a contraindication for augmentation of labor. Increasing uterine contractions with oxytocin could further compromise fetal oxygenation, potentially leading to severe fetal hypoxia. In this scenario, alternative interventions to improve fetal well-being or a cesarean delivery may be necessary.
Choice B rationale
Placenta previa, a condition where the placenta partially or completely covers the cervix, is an absolute contraindication for vaginal birth and labor augmentation. The increased contractions from oxytocin could lead to placental separation and massive hemorrhage, endangering both the mother and the fetus. A cesarean delivery is indicated for this condition.
Choice C rationale
Active genital herpes lesions present a high risk of transmitting the herpes simplex virus to the newborn during passage through the birth canal. This can cause severe neonatal morbidity and mortality. Therefore, a vaginal birth is contraindicated, and labor augmentation with oxytocin would not be an appropriate intervention. A cesarean delivery is the recommended course of action.
Choice D rationale
Hypertension of pregnancy or gestational hypertension, as long as it is not severe and there are no signs of fetal compromise or placental insufficiency, is a common reason for labor induction or augmentation. Augmentation with oxytocin can be used carefully to manage labor progression while the patient is closely monitored for signs of worsening hypertension, and the fetus is monitored for distress.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is C
Explanation
Choice A rationale
Rupture of the amniotic membranes is a natural part of labor progression and a common procedure for labor induction or augmentation. While it is an important event to note and monitor for potential complications like cord prolapse, it is not a direct contraindication for oxytocin administration unless other signs of fetal or maternal compromise are present.
Choice B rationale
A fetal heart rate of 140 beats per minute with accelerations is considered a normal, reassuring finding. The normal fetal heart rate range is 110-160 beats per minute. Accelerations indicate a healthy fetal response to stimulation and adequate oxygenation. Therefore, this finding would support the continuation of oxytocin, not its discontinuation.
Choice C rationale
Uterine hyperstimulation, defined as more than five contractions in 10 minutes, is a significant complication of oxytocin augmentation. This can lead to fetal distress due to reduced uteroplacental blood flow during contractions. The prolonged and frequent contractions can compromise oxygen delivery to the fetus, necessitating immediate discontinuation of the oxytocin infusion to prevent adverse outcomes.
Choice D rationale
A patient needing to void is a normal physiological need. While the nurse should ensure the patient voids regularly to prevent bladder distention, which can impede fetal descent, it is not an indication to discontinue the oxytocin infusion. This action can be managed without interrupting the medication administration.
Correct Answer is B
Explanation
Choice A rationale
A fetus in a longitudinal lie, cephalic presentation, is positioned with its long axis parallel to the mother's spine, with the head presenting first. This is the most common and favorable position for vaginal delivery. The illustration depicts a vertical alignment of the fetus within the uterus.
Choice B rationale
A transverse lie is a fetal malpresentation where the long axis of the fetus is perpendicular to the long axis of the mother. The fetus's head and buttocks are positioned to the sides of the mother's abdomen, with the shoulder or trunk presenting first.
Choice C rationale
A fetus in a longitudinal lie, breech presentation, is positioned with its long axis parallel to the mother's spine. The fetal buttocks or feet are presenting first into the pelvic inlet. The illustration depicts a vertical alignment of the fetus with the head at the top of the uterus.
Choice D rationale
An oblique lie is an unstable fetal position where the fetal long axis is at an angle to the maternal long axis. This position often converts to a longitudinal or transverse lie during labor. The illustration depicts an angled fetal position, but it is not a true transverse lie. .
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