The primiparous patient is at 42 weeks' gestation. What order ...

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The primiparous patient is at 42 weeks' gestation. What order should the nurse question?
 
  1. Obtain biophysical profile today.
  2. Begin nonstress test now.
  3. Schedule labor induction for tomorrow.
  4. Return to the clinic in one week.

Question 2

Two hours ago, the 39-weeks'-gestation patient was 3 cm dilated, 40 effaced, and +1 station. Frequency of contractions was every five minutes with duration 40 seconds and intensity 50 mmHg.
 
  The current assessment is 4 cm dilated, 40 effaced, and +1 station. Frequency of contractions is now every three minutes with 4050 seconds' duration with intensity of 40 mmHg. The priority intervention would be:
  1. Begin oxytocin after assessing for CPD.
  2. Give Terbutaline to stop the preterm labor.
  3. Start oxygen at 8 L/min.
  4. Have anesthesia give the patient an epidural.

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Answer to Question 1

Correct Answer: 4
Rationale 1: A biophysical profile is a commonly used assessment for the post-term fetus.
Rationale 2: The nonstress test is a commonly used assessment for the post-term fetus.
Rationale 3: Labor induction is likely to occur with post-term pregnancies because the aging placenta becomes less efficient at transporting oxygen and nutrients and because the risk of fetal macrosomia increases with length of gestation.
Rationale 4: A post-term pregnancy is high-risk. Fetal assessments must be obtained to verify fetal well-being or the need for delivery via induction or cesarean. One week is too long a time period between assessments.

Answer to Question 2

Correct Answer: 1
Rationale 1: The patient is having hypertonic contractions. The presence of CPD can prolong labor, so it is important to rule this out. Oxytocin (Pitocin) can create a more productive labor pattern by strengthening the contractions.
Rationale 2: Terbutaline would not be recommended. The contraction pattern is incoordinate, but they need to be enhanced, not stopped.
Rationale 3: Oxygen will not hurt, but it is not the priority.
Rationale 4: An epidural will not change the incoordinate contraction pattern.