A woman is about to undergo an external version. What action by ...

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A woman is about to undergo an external version. What action by the nurse takes priority?
 
  A.
  Determine Rh status; give Rh immune globulin if needed.
  B.
  Explain the procedure to the woman and obtain consent.
  C.
  Offer emotional support to both the woman and her partner.
  D.
  Prepare to administer oxytocin (Pitocin) as per protocol.

Question 2

A woman at 30 weeks' gestation is 80 effaced and 5 cm dilated. Which action by the nurse takes priority?
 
  A.
  Arrange a palliative care consult for probable fetal demise.
  B.
  Encourage the woman to attempt a trial of labor before undergoing a cesarean section.
  C.
  Ensure that informed consent for a cesarean birth is on the chart.
  D.
  Inform the woman that if the tocolytic therapy is successful, she will deliver.

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Answer to Question 1

ANS: A
Because the version can cause feto-maternal bleeding, women who are Rh-negative should receive Rh immune globulin (RhoGAM). Offering emotional support is always important, but does not take priority over keeping the patient safe. The physician is responsible for explaining the procedure. Because uterine relaxation is important for a successful version, tocolytic medications may be given (not medications that increase uterine tone).

Answer to Question 2

ANS: C
In preterm labor, if the woman's membranes have ruptured or if her cervix is more than 50 effaced and 3-4 cm dilated, it is not likely that the labor can be stopped. A cesarean birth is preferable to a vaginal delivery because it diminishes pressure on the fetal head and decreases the risk of intracranial hemorrhage. Because there is a high likelihood of cesarean birth, the nurse should ensure that consent for cesarean delivery is on the chart, in the event that the labor cannot be halted. Tocolytic medications are administered to halt contractions; if unsuccessful, the birth will occur.

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