When the client receiving an oxytocin (Pitocin) drip at 16 mU/min ...

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When the client receiving an oxytocin (Pitocin) drip at 16 mU/min develops hypertonic stimulation, FHR 138 bpm with accelerations, and no decelerations, the nurse's best response would be to:
 
  a. stop the drip immediately.
  b. decrease the dose to 14 mU/min.
  c. reassess the patient at 5 minute intervals.
  d. reposition the patient to the left side-lying position.

Question 2

In which client situation could an amniotomy be safely performed?
 
  a. G1 P0, 38 weeks' gestation, 20 effaced, closed cervix
  b. G2 P1, 40 weeks' gestation, with fetus in a breech presentation
  c. G2 P0, 39 weeks' gestation, 70 effaced, cervix dilated 2 cm
  d. G3 P2, 41 weeks' gestation, early labor complicated with hydramnios

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Answer to Question 1

ANS: B
In the absence of any adverse fetal response, hypertonic stimulation can be managed by reducing the infusion rate by 1 to 2 mU/min until uterine hyperstimulation is resolved. Stopping the drip immediately is not necessary unless hyperstimulation continues and adverse fetal responses occur. Reassessing and repositioning are of no benefit in this situation.

Answer to Question 2

ANS: C
The cervix must be partially open to allow the membranes to be ruptured. An amniotomy cannot be performed when the cervix is closed. Breech presentation would be delivered by cesarean section and membranes would be ruptured at birth. Rupturing the membranes in a client with hydramnios can result in abruptio placentae.

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TYSM

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