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A client with pre-eclampsia with severe features at 38 weeks' gestation is being induced with IV oxytocin.
Which of the following would warrant the nurse to stop the infusion?

A.

Blood pressure 160/110.

B.

Frequency of contractions every 3 minutes.

C.

Fetal heart rate 155 bpm with early decelerations.

D.

Frequency of contractions every 3 minutes.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Blood pressure of 160/110 indicates severe preeclampsia and warrants immediate intervention to prevent complications. Stopping oxytocin is part of the management of severe

preeclampsia to avoid exacerbating the condition.

 

Choice B rationale

Frequency of contractions every 3 minutes is within the normal range during labor induction and does not warrant stopping the infusion unless there are other concerns.

 

Choice C rationale

A fetal heart rate of 155 bpm with early decelerations may require close monitoring but does not necessarily warrant stopping the oxytocin infusion. Early decelerations are typically a

normal physiological response.

 

Choice D rationale

Frequency of contractions every 3 minutes is expected during active labor and is generally not a cause to stop the oxytocin infusion. The nurse should continue to monitor the labor

progression closely.


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View Related questions

Correct Answer is B

Explanation

Choice A rationale

Contraction duration less than 40 seconds doesn't define tachysystole. Tachysystole focuses on frequency, not duration, of contractions over a specific time frame.

Choice B rationale

Contraction frequency of more than 5 in 10 minutes defines tachysystole. This frequency indicates excessive uterine activity, requiring intervention to prevent fetal distress.

Choice C rationale

Contraction intensity less than 80 mm Hg does not define tachysystole. Intensity relates to contraction strength, but tachysystole is about frequency exceeding the normal range.

Choice D rationale

Resting tone less than 18 mm Hg isn't part of tachysystole's definition. Tachysystole pertains to contraction frequency, not resting tone, which measures uterine relaxation between contractions.

Correct Answer is C

Explanation

Choice A rationale

Dexamethasone does not directly stop labor contractions; instead, it is used to enhance fetal lung maturity.

Choice B rationale

Dexamethasone is not for infection prevention; antibiotics are used for that purpose in cases of premature rupture of membranes.

Choice C rationale

Dexamethasone is administered to enhance fetal lung maturity, reducing the risk of respiratory distress syndrome in preterm infants.

Choice D rationale

Dexamethasone is not used for pain relief in preterm labor; other medications are prescribed for pain management.

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