Editing Maternal and Newborn Nursing – RN Practice Questions (section)

==Question 5==
A nurse reviewing a fetal monitor tracing observes a baseline of 145 beats per minute with minimal variability and repetitive decelerations that begin after the peak of each contraction and return to baseline after the contraction ends. Oxytocin is infusing at 8 milliunits per minute. Which action should the nurse take '''first'''?
# Discontinue the oxytocin infusion.
# Increase the IV maintenance fluid rate.
# Apply oxygen at 10 L/min by nonrebreather mask.
# Prepare the client for immediate cesarean birth.

'''Answer:''' 1 (A). Discontinue the oxytocin infusion.

''Rationale:'' Recurrent late decelerations with minimal variability indicate uteroplacental insufficiency. Contractions reduce placental perfusion, so removing the stimulus that is causing them is the first and most effective step, and stopping oxytocin is an independent nursing action that does not require an order. Fluid bolus (option 2) and oxygen (option 3) are also part of intrauterine resuscitation, along with lateral repositioning, but they follow removal of the cause. Option 4 may become necessary if the pattern does not resolve, but it is not the nurse's first action and requires provider evaluation.