The primary healthcare provider for a client at 38 1/7 weeks' gestation calls the labor and delivery suite to schedule an induction for the next day. The client is having no medical or pregnancy complications.
Which of the following responses by the nurse would be appropriate?
At what time would you like to begin the induction?
What is the client's Bishop score?
I am sorry but the client will not be able to be induced tomorrow.
I will have the prostaglandin induction medication prepared.
The Correct Answer is B
Choice A rationale
Induction timing is secondary to assessing readiness. The Bishop score determines cervical favorability for induction success.
Choice B rationale
The Bishop score assesses cervical readiness for labor induction, which is vital in planning an effective induction.
Choice C rationale
Refusal to induce without considering clinical data is inappropriate. The Bishop score evaluation determines readiness.
Choice D rationale
Prostaglandin preparation follows Bishop score assessment to ensure induction safety and efficacy.
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Correct Answer is A
Explanation
Choice A rationale
Postpartum psychosis is a serious mental health condition that can result in delusions and hallucinations. These symptoms increase the risk of harm to the infant, so it's essential that
the mother is not left alone with the baby to ensure both their safety.
Choice B rationale
Symptoms of postpartum psychosis typically last longer than one week and require medical intervention, contrary to what is stated in this choice. Treatment usually involves
antipsychotics, mood stabilizers, and sometimes hospitalization.
Choice C rationale
Clinical response to medications can be significant in many cases, and early and aggressive treatment often leads to improvement. This statement is inaccurate and does not reflect
the current understanding of postpartum psychosis treatment.
Choice D rationale
While monitoring vital signs is essential, it is not as critical as ensuring the infant's safety given the mother’s severe mental condition. The focus should be on psychiatric
management and safety protocols rather than routine vitals alone.
Correct Answer is A
Explanation
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.