The nurse is caring for a patient in labor and has administered oxytocin (Pitocin) to augment labor. What clinical manifestation would cause the nurse to completely discontinue the medication?
a. Contractions lasting longer than 60 seconds
b. Contractions occurring every 2 to 3 minutes
c. Uterine baseline tone (resting pressure) of 12 mm Hg
d. Regular fetal heart rate of 130 beats per minute
A
The nurse would discontinue the medication if contractions lasting longer than 60 seconds oc-curred, because this may indicate maternal and/or fetal distress.
Contractions occurring every 2 to 3 minutes are considered normal.
Complications that usually require interruption of the infusion are elevation of resting uterine pressure above 15 to 20 mm Hg so this response is considered normal.
The fetal heart rate of 130 beats per minute is normal and this response also says the fetal heart rate is regular.
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