The nurse is creating a plan of care for a patient in labor. Which nursing diagnosis would have priority for a patient receiving intravenous oxytocin (Pitocin)?

Question

a. Risk for impaired comfort
b. Risk for urinary retention
c. Risk for nutrition, more than body requirements
d. Risk for fluid volume excess

Answer 1

D
The most appropriate nursing diagnosis, which would take priority, is risk for fluid volume excess. IV oxytocin causes water retention, and the patient should be monitored for water intoxication.
Oxytocin poses no risk for urinary retention or impaired comfort.
There is no apparent indication that the patient is at risk for excess nutrition.