Dysfunctional Labor (Dystocia) Practice Exam

EXPLANATION

✔Correct answer:

A uterine fibroid was discovered during a previous cesarean section. Uterine fibroids are benign tumors that can interfere with normal uterine contractions and labor progression. The presence of a fibroid can distort the uterine cavity, impede the descent of the fetus, and affect the effectiveness of uterine contractions, potentially leading to dysfunctional labor. The fibroid could act as a physical barrier, preventing the baby from moving into the birth canal properly or could cause the uterus to contract irregularly, leading to ineffective labor. Given this history, Nurse Davis should be vigilant for signs of dysfunctional labor during this pregnancy.

Uterine fibroids can vary in size and location within the uterus. Depending on their size and location, fibroids can lead to malpresentation of the fetus, obstructed labor, or failure of the uterus to contract effectively. In labor, a large or poorly positioned fibroid may prevent the cervix from dilating properly or block the fetus's descent, necessitating interventions such as cesarean delivery.

Think of the uterus as a football field where the baby is the ball that needs to move towards the goal (the birth canal). A fibroid can be like a large rock on the field, making it difficult for the ball to move smoothly towards the goal, leading to potential delays or obstacles in the process.

Knowing the presence of a uterine fibroid in a previous pregnancy, the nurse should closely monitor labor progression and be prepared for possible complications. Interventions may include more frequent assessments of fetal position and progress of labor, possible imaging to reassess fibroid size or location, and readiness for surgical intervention if necessary.

• Monitor labor progress closely for signs of obstruction or ineffective contractions.
• Assess fetal position frequently, as fibroids can cause malpresentation.
• Collaborate with the healthcare team to plan for potential cesarean delivery if labor does not progress or complications arise.
• Provide patient education on the possible impact of fibroids on labor and delivery.
• Ensure continuous fetal monitoring to detect any signs of fetal distress due to labor complications.

✘Incorrect answer options:

Membranes were ruptured for 24 hours during her second delivery. While prolonged rupture of membranes increases the risk for infection (e.g., chorioamnionitis), it does not directly cause dysfunctional labor. This history would be more relevant for monitoring signs of infection rather than anticipating dysfunctional labor.

First labor lasted for 24 hours. Prolonged labor can be due to various factors, including a first-time mother (primipara) or issues with the fetus's position. While it suggests a need to monitor labor duration, it does not necessarily indicate a predisposition for dysfunctional labor in future pregnancies unless there are specific underlying causes like cephalopelvic disproportion or fibroids.

Second delivery required a cesarean due to face presentation. Face presentation is an abnormal fetal position where the face is the leading part during delivery. While this may require cesarean delivery, it is usually a specific situation for that pregnancy and does not predict dysfunctional labor in future pregnancies unless other complicating factors, such as fibroids or pelvic abnormalities, are present.

EXPLANATION

✔Correct answer:

Implement pain relief strategies. The primary nursing intervention for a patient with hypertonic uterine dysfunction is to implement pain relief strategies. Hypertonic uterine dysfunction is characterized by frequent, uncoordinated, and painful contractions that are ineffective in progressing labor. These contractions can lead to maternal exhaustion, increased stress, and fetal distress. Pain management is essential to help reduce the intensity of contractions, allow the mother to rest, and potentially facilitate more effective labor patterns.

Hypertonic uterine dysfunction occurs when the uterus contracts with high frequency and intensity, but in a disorganized and non-productive manner. These ineffective contractions do not lead to adequate cervical dilation or fetal descent, causing prolonged and painful labor. Managing the patient’s pain can help in reducing the frequency and intensity of these contractions, allowing the uterus to rest and potentially reset to a more coordinated and effective contraction pattern.

Imagine a car engine that’s revving too high and overheating without actually moving the car forward. Just like the engine needs to cool down to function properly, the uterus needs relief from excessive contractions to resume effective labor.

Effective pain management may include the use of analgesics, sedatives, or epidural anesthesia. The nurse should also ensure a calm and supportive environment to help reduce stress, which can exacerbate hypertonic contractions. Monitoring maternal and fetal status continuously is crucial, as prolonged hypertonic contractions can lead to fetal hypoxia and maternal exhaustion.

• Administer prescribed analgesics or sedatives to help reduce the intensity of contractions and allow the patient to rest.
• Consider non-pharmacological pain relief methods such as breathing techniques, warm baths, or massages.
• Continuously monitor the fetal heart rate for signs of distress, as hypertonic contractions can reduce fetal oxygenation.
• Provide emotional support and reassurance to the patient, as anxiety can exacerbate the condition.

✘Incorrect answer options:

Closely monitor the Pitocin infusion. Pitocin (oxytocin) is typically used to strengthen contractions, but in the case of hypertonic uterine dysfunction, the contractions are already overly frequent and intense. Administering or increasing Pitocin could worsen the condition, so this is not the priority intervention.

Get the patient ready for an amniotomy. An amniotomy, or artificial rupture of membranes, is used to induce or accelerate labor. However, in hypertonic uterine dysfunction, the issue is not the lack of contractions, but rather their ineffective nature. Amniotomy is not the first-line treatment in this scenario and could potentially increase the risk of complications.

Encourage walking every 30 minutes. Ambulation is generally encouraged in normal labor to help progress. However, in the case of hypertonic uterine dysfunction, walking may exacerbate the condition by increasing the frequency and intensity of already erratic contractions, leading to further maternal exhaustion.

EXPLANATION

✔Correct answer:

A uterine rupture. The scenario described is highly suggestive of a uterine rupture, especially given the patient's history of a previous cesarean section (C-section). Uterine rupture is a rare but serious obstetric emergency in which the wall of the uterus tears during pregnancy or labor. This condition can be life-threatening for both the mother and the fetus and requires immediate medical intervention.

Uterine rupture often occurs along the scar line from a previous C-section, especially during labor when the uterine muscles are under significant stress. The signs and symptoms described in the question—including severe abdominal pain, tetanic contractions (prolonged and unrelenting contractions), vomiting, and a brief relief of pain followed by loss of consciousness—are classic indicators of uterine rupture. The brief relief of pain occurs when the uterus tears completely, momentarily releasing the pressure. Loss of consciousness may occur due to hemorrhagic shock from internal bleeding.

Imagine a balloon (the uterus) that has a patched area (C-section scar). If the balloon is overinflated (labor stress), the patched area might give way, causing the balloon to burst. This is similar to what happens in a uterine rupture where the scarred area of the uterus tears.

Uterine rupture is a medical emergency that requires immediate surgical intervention, typically an emergency cesarean section. The nurse's priority is to recognize the signs and symptoms early and to facilitate rapid communication and transfer to the operating room.

• Immediately notify the obstetrician and the surgical team.
• Prepare the patient for emergency surgery.
• Administer oxygen and initiate intravenous fluid resuscitation to manage shock.
• Continuously monitor maternal vital signs and fetal heart rate.
• Provide emotional support to the patient and her family, as this is a highly stressful situation.

✘Incorrect answer options:

Extreme anxiety combined with the flu. While extreme anxiety can cause symptoms such as nausea and vomiting, it does not explain the tetanic contractions or severe abdominal pain. Additionally, the flu would present with respiratory symptoms, fever, and generalized malaise, rather than acute, localized abdominal pain and contractions.

A placental abruption. Placental abruption, the premature separation of the placenta from the uterine wall, can present with severe abdominal pain and vaginal bleeding. However, the presence of tetanic contractions and the brief relief of pain before loss of consciousness are more indicative of uterine rupture rather than abruption. Additionally, placental abruption typically involves continuous, intense pain rather than the sudden cessation of pain.

Dysfunctional labor. Dysfunctional labor refers to labor that does not progress normally, often due to ineffective uterine contractions. While this can cause prolonged labor and discomfort, it does not explain the sudden onset of severe pain, vomiting, and subsequent loss of consciousness. Dysfunctional labor is not associated with the life-threatening presentation seen in this case.

EXPLANATION

✔Correct answer:

Starting an oxytocin (Pitocin) infusion. The most appropriate treatment for hypotonic uterine dysfunction is typically the administration of oxytocin (Pitocin). Hypotonic uterine dysfunction refers to a condition in which the strength, frequency, or duration of uterine contractions is insufficient to advance labor effectively. Oxytocin is a medication commonly used to stimulate or enhance uterine contractions, thereby helping to progress labor when it has slowed due to weak contractions.

During labor, effective uterine contractions are essential to dilate the cervix and push the baby through the birth canal. In hypotonic uterine dysfunction, the contractions are too weak (hypotonic) to cause cervical dilation or to help with the descent of the fetus. By administering oxytocin, the strength and frequency of contractions are increased, improving the effectiveness of labor and helping to prevent complications such as prolonged labor or fetal distress.

Imagine trying to push a heavy object up a hill. If you push weakly, the object doesn't move very far. But if you apply more force, the object starts to move up the hill. Similarly, oxytocin provides that extra "push" to help move labor along more effectively.

When oxytocin is administered, the nurse must monitor the patient closely for signs of hyperstimulation (excessively frequent or strong contractions), which could lead to fetal distress. Continuous fetal heart rate monitoring is crucial, as well as assessing the frequency, duration, and intensity of contractions.

• Monitor the patient’s contraction pattern and adjust the oxytocin infusion rate according to the physician’s orders and hospital protocol.
• Continuously monitor the fetal heart rate for any signs of distress, which could indicate excessive uterine activity.
• Assess the patient for any side effects or complications from oxytocin, such as uterine hyperstimulation or water intoxication.

✘Incorrect answer options:

A sedative medication. Sedatives are generally not used to manage hypotonic uterine dysfunction. Sedatives might be prescribed for hypertonic uterine dysfunction (excessively frequent and painful contractions), but they are not appropriate for increasing the strength of contractions.

Enhancing the patient's hydration. While adequate hydration is important during labor, simply enhancing hydration is unlikely to resolve hypotonic uterine dysfunction. Hydration can help in cases of dehydration-related uterine dysfunction, but oxytocin is more directly effective in stimulating stronger contractions.

Administering a tocolytic drug. Tocolytics are medications that are used to suppress uterine contractions, typically to delay preterm labor. They are contraindicated in hypotonic uterine dysfunction, as they would further reduce contraction strength, worsening the labor progression.

EXPLANATION

✔Correct answer:

Assess fetal heart rate and uterine contraction patterns. When administering Oxytocin (Pitocin) to a laboring patient, the most critical nursing intervention is to continuously monitor the fetal heart rate (FHR) and uterine contraction patterns. Oxytocin is used to augment labor by increasing the frequency and intensity of uterine contractions. However, if not carefully monitored, it can lead to hyperstimulation of the uterus, which may cause complications such as uterine tachysystole (excessive contractions), reduced uteroplacental blood flow, and fetal distress. By assessing FHR and contraction patterns, the nurse can detect early signs of fetal distress or hyperstimulation and take immediate action, such as reducing or discontinuing the Oxytocin infusion, repositioning the patient, or administering oxygen.

Hypotonic dystocia is characterized by weak and inefficient contractions that fail to progress labor. Oxytocin helps strengthen uterine contractions, but if contractions become too strong or too frequent, it can compromise the oxygen supply to the fetus. Continuous monitoring ensures that both maternal and fetal safety are maintained during labor augmentation.

Imagine trying to fill a balloon with water. If you fill it too slowly, nothing happens, but if you fill it too quickly or with too much force, the balloon might burst. Similarly, with Oxytocin, the goal is to find the right balance of contractions to progress labor without causing harm to the mother or fetus.

The nurse should prioritize continuous electronic fetal monitoring (EFM) and frequent assessment of uterine contractions to identify any adverse effects of Oxytocin administration. The nurse should be prepared to intervene promptly if abnormal FHR patterns or excessive contractions are observed.

• Monitor FHR continuously to detect any signs of fetal distress.
• Assess uterine contraction strength, frequency, and duration to ensure they are within safe limits.
• Adjust the Oxytocin infusion rate as per protocol or physician orders, based on the response of the uterus and fetus.
• Provide maternal comfort measures, such as positioning changes, to optimize uteroplacental blood flow.
• Document all assessments and interventions accurately to ensure comprehensive care and communication with the healthcare team.

✘Incorrect answer options:

Administer IV fluids to prevent dehydration. While maintaining hydration is important, it is not the most critical intervention in this scenario. The primary concern with Oxytocin administration is the potential for uterine hyperstimulation and its effects on fetal oxygenation, making FHR and contraction monitoring the priority.

Monitor the maternal blood pressure every hour. Monitoring maternal blood pressure is an important aspect of care, particularly when administering medications like Oxytocin. However, it should be done more frequently than every hour when there are potential risks of complications like uterine hyperstimulation. Continuous fetal and uterine monitoring remains the top priority.

Encourage the patient to ambulate frequently. Ambulation can be beneficial for labor progression, especially in cases of hypotonic labor. However, once Oxytocin is initiated, continuous monitoring becomes essential, which typically limits the ability to ambulate freely. The focus should be on ensuring the safety of the fetus and the effectiveness of the medication through close monitoring.

EXPLANATION

✔Correct answer:

Progressive cervical dilation. The primary goal of administering IV Pitocin (Oxytocin) for a patient with secondary dystocia (a labor that has stalled after initially progressing) is to stimulate more effective uterine contractions, leading to progressive cervical dilation. Oxytocin is a synthetic hormone that mimics the body's natural labor-inducing hormone, promoting stronger and more coordinated contractions. The expected outcome of this intervention is that the contractions will become strong and regular enough to overcome the factors causing the dystocia, resulting in continued dilation of the cervix.

During labor, cervical dilation is necessary for the fetus to pass through the birth canal. Secondary dystocia occurs when labor slows or stops due to inadequate contractions, fetal malposition, or other factors. By administering Pitocin, the nurse aims to restore the labor’s momentum, leading to regular, strong contractions that facilitate cervical dilation and eventual delivery.

Think of labor as trying to push a heavy object (the baby) across a room (the birth canal). If you’re not pushing hard enough (weak contractions), the object won’t move (the cervix won’t dilate). Pitocin helps you push harder and more effectively, moving the object across the room (progressing the labor).

Nurse Thompson should closely monitor the patient’s contraction pattern and cervical changes. Continuous fetal monitoring is also essential to ensure that the fetus tolerates the increased contraction intensity. The nurse should adjust the Pitocin dosage as needed according to the labor progress and the healthcare provider’s orders.

• Monitor the frequency, duration, and intensity of contractions to ensure they are effective in promoting cervical dilation.
• Regularly assess cervical dilation and effacement to evaluate the effectiveness of the Pitocin infusion.
• Monitor the fetal heart rate to detect any signs of fetal distress caused by increased uterine activity.
• Adjust the Pitocin infusion rate based on the progress of labor and the patient's response.
• Provide comfort measures and support to the patient as contractions intensify.

✘Incorrect answer options:

A painless delivery. While pain management is an important aspect of labor care, Pitocin is not intended to create a painless delivery. In fact, Pitocin often leads to stronger contractions, which may increase discomfort. Painless delivery is not a realistic or expected outcome of Pitocin infusion.

Cervical effacement. Although cervical effacement (thinning of the cervix) is an important part of labor, the key indicator of effective Pitocin administration in the context of secondary dystocia is progressive cervical dilation, not just effacement. Effacement typically occurs earlier and does not directly indicate the effectiveness of the Pitocin.

Infrequent contractions. Infrequent contractions would indicate that the Pitocin is not effective. The desired outcome of Pitocin infusion is to achieve regular, strong contractions that lead to progressive cervical dilation, not infrequent ones.

EXPLANATION

✔Correct answer:

Continuously monitoring the fetal heart rate. In the context of dystocia, which refers to abnormal or difficult labor, the primary concern for the nurse is ensuring the well-being of the fetus. Continuous monitoring of the fetal heart rate (FHR) is essential as it provides real-time information on the fetal response to labor. Fetal distress, which can result from prolonged labor, uteroplacental insufficiency, or cord compression, can be detected early through FHR monitoring. Prompt detection allows for timely interventions, which are crucial for preventing adverse outcomes such as fetal hypoxia or acidosis.

Dystocia may result from various factors, including inadequate uterine contractions, abnormal fetal position, or a small pelvis relative to the fetal size. These conditions can compromise the oxygen supply to the fetus during labor. Fetal heart rate monitoring helps assess whether the fetus is tolerating labor well or if there are signs of distress, such as bradycardia, tachycardia, or late decelerations.

Think of the fetal heart rate monitor as a car’s dashboard warning lights. Just as those lights alert the driver to potential issues with the car, the FHR monitor alerts the healthcare team to any potential issues with the fetus, enabling them to take action before a serious problem occurs.

Nurses should prioritize continuous fetal monitoring, particularly in cases of dystocia, to ensure early detection of fetal distress. This may include using electronic fetal monitoring (EFM) to track FHR patterns. If abnormalities are detected, the nurse should be prepared to initiate interventions such as repositioning the patient, administering oxygen, or notifying the healthcare provider for potential expedited delivery.

• Maintain continuous fetal heart rate monitoring and document findings regularly.
• Be alert to any signs of fetal distress and promptly report them to the healthcare provider.
• Educate the patient and partner about the importance of FHR monitoring and any interventions that may be necessary.
• Prepare for possible interventions, such as cesarean delivery, if the fetal condition warrants it.

✘Incorrect answer options:

Keeping the partner updated on the labor’s progress. While keeping the partner informed is an important part of holistic care and supports family-centered care, it does not take precedence over ensuring fetal safety. Continuous fetal monitoring directly impacts the immediate health and safety of the fetus and is thus a higher priority.

Ensuring comfort measures are provided. Comfort measures, such as pain management and positioning, are essential to maternal well-being but are secondary to ensuring fetal health. If the fetus is in distress, addressing comfort alone will not resolve the underlying issue that could lead to serious complications.

Regularly changing the patient's position. Regular position changes can help facilitate labor progress and are important in managing dystocia. However, continuous fetal heart rate monitoring is more critical because it directly impacts the assessment of fetal well-being, making it the top priority.

EXPLANATION

✔Correct answer:

A full bladder. A full bladder can impede the progress of labor by physically obstructing the descent of the fetus through the birth canal and reducing the effectiveness of uterine contractions. Nurse Williams can manage this independently by encouraging the patient to void regularly or by inserting a urinary catheter if the patient is unable to urinate. By ensuring that the bladder remains empty, the nurse can help facilitate more effective contractions and promote the progress of labor.

During labor, a full bladder can occupy space in the pelvis, which may prevent the fetal head from engaging properly and can reduce the strength and coordination of uterine contractions. Emptying the bladder alleviates this obstruction, allowing for better alignment of the fetus and more effective labor.

Think of labor as trying to fit a key (the baby) into a lock (the pelvis). If there’s something blocking the keyhole, like a full bladder, it’s difficult for the key to fit properly. Removing the obstruction allows the key to turn smoothly, just like emptying the bladder helps labor progress.

Nurse Williams should assess the patient’s bladder status regularly during labor, especially if labor progress seems slow. She can encourage the patient to void every 2 hours or as needed, or she can implement catheterization if necessary. Monitoring the patient’s comfort and ensuring bladder emptying can contribute significantly to managing dysfunctional labor caused by this issue.

• Encourage the patient to void regularly, every 2 hours if possible, to keep the bladder empty.
• Assess bladder distention through palpation if the patient reports discomfort or if labor is not progressing.
• Consider inserting a urinary catheter if the patient is unable to void, especially if an epidural is in place, as this can reduce the ability to sense a full bladder.
• Monitor labor progress after bladder emptying to evaluate the effectiveness of the intervention.

✘Incorrect answer options:

Pelvic bone contraction. Pelvic bone contraction refers to a situation where the pelvis is too small or misshapen to allow the fetus to pass through. This is a structural issue that cannot be managed by a nurse independently; it may require medical or surgical intervention, such as a cesarean delivery.

Extension rather than flexion of the fetal head. This refers to the fetal head being in an abnormal position, which can complicate labor. While the nurse can perform positional changes to help encourage proper alignment of the fetus, managing fetal malposition usually requires collaborative efforts with the healthcare provider, such as attempting manual rotation or using instruments.

Cervical rigidity. Cervical rigidity means that the cervix is not softening or dilating as expected during labor. This condition may require medical interventions such as administration of medications (e.g., prostaglandins) or more aggressive measures, which are beyond the scope of independent nursing management.

EXPLANATION

✔Correct answer:

Intrauterine fetal death. Disseminated intravascular coagulation (DIC) is a severe condition characterized by widespread activation of the clotting cascade, leading to the formation of clots in small blood vessels throughout the body. This process consumes clotting factors and platelets, which can result in severe bleeding. One of the most significant risk factors for developing DIC in obstetric patients is intrauterine fetal death (IUFD), particularly when the fetus has been retained for an extended period.

In cases of IUFD, the breakdown of fetal tissue within the uterus can release thromboplastin into the maternal bloodstream. Thromboplastin is a potent trigger for the coagulation cascade, leading to widespread clot formation in the blood vessels. This excessive clotting depletes the body’s supply of clotting factors and platelets, causing a paradoxical situation where the patient is at risk for both thrombosis and severe bleeding.

Imagine your body’s clotting system as a team of firefighters (clotting factors) on standby to control small fires (bleeding). In the case of DIC triggered by something like an intrauterine fetal death, it’s as if an alarm goes off signaling multiple fires all at once. The firefighters rush out, using up all their resources (clotting factors) to fight these fires. But soon, they run out of water and equipment (clotting resources), leaving them unable to respond to new fires and causing uncontrollable fires (bleeding) to spread.

Nurses must be aware of the signs and symptoms of DIC, including unusual or excessive bleeding, bruising, or signs of thrombosis (e.g., deep vein thrombosis, pulmonary embolism). Immediate medical intervention is required, including addressing the underlying cause (such as delivering the fetus in the case of IUFD) and supporting the patient with blood products and clotting factor replacement as needed.

• Monitor for signs of bleeding, such as petechiae, ecchymosis, hematuria, or bleeding from IV sites.
• Assess coagulation studies regularly, including platelet count, fibrinogen levels, and D-dimer.
• Provide emotional support to the patient and family, as IUFD is a devastating event.
• Prepare for possible administration of blood products, such as fresh frozen plasma or platelets.
• Collaborate with the healthcare team to manage the underlying cause and prevent further complications.

✘Incorrect answer options:

Placenta accreta. Placenta accreta is a condition where the placenta abnormally adheres to the uterine wall, which can lead to severe postpartum hemorrhage. While this condition poses a risk for bleeding, it is not directly associated with the development of DIC unless severe hemorrhage occurs that leads to secondary DIC.

Dysfunctional labor. Dysfunctional labor refers to abnormal labor patterns, such as prolonged or ineffective contractions. While this can complicate labor and delivery, it is not a direct risk factor for DIC unless it leads to significant complications like severe hemorrhage or fetal demise.

Premature rupture of membranes. Premature rupture of membranes (PROM) involves the early breaking of the amniotic sac, which can increase the risk of infection. However, it is not directly associated with DIC unless complications such as infection or severe hemorrhage develop, which are less common.

EXPLANATION

✔Correct answer:

Uterine tetany. During the induction of labor, particularly when using medications such as Oxytocin (Pitocin), the most critical concern for the nurse is to monitor for uterine tetany. Uterine tetany, also known as uterine hyperstimulation, refers to excessively frequent, prolonged, or intense contractions, typically defined as contractions lasting more than 2 minutes, occurring more frequently than 5 contractions in 10 minutes, or having less than 60 seconds of resting tone between contractions. This condition can lead to reduced blood flow to the placenta, resulting in fetal distress due to decreased oxygen supply. It can also increase the risk of uterine rupture, especially in patients with previous uterine surgery, such as a cesarean section.

The uterus requires a period of relaxation between contractions to allow for adequate placental blood flow and fetal oxygenation. Uterine tetany disrupts this balance, which can lead to fetal hypoxia, acidosis, and, if untreated, can compromise the fetus's well-being. Early recognition and intervention are crucial to prevent serious complications.

Imagine the uterus as a sponge that needs to contract and relax in cycles to absorb water (blood and oxygen). If you keep squeezing the sponge without allowing it to relax, it won’t be able to absorb enough water, leading to a dry sponge (fetal distress).

Nurse Miller should closely monitor the frequency, duration, and intensity of uterine contractions and fetal heart rate patterns. If signs of uterine tetany are observed, the nurse should immediately stop the Oxytocin infusion, reposition the patient to improve placental blood flow, administer oxygen if needed, and notify the healthcare provider.

• Monitor contraction patterns continuously, especially when administering Oxytocin.
• Assess the fetal heart rate frequently for signs of distress, such as late decelerations or bradycardia.
• If uterine tetany is detected, stop the Oxytocin infusion immediately and notify the provider.
• Reposition the patient to a lateral position to enhance placental perfusion.
• Prepare to administer tocolytics (medications to relax the uterus) if ordered by the provider.

✘Incorrect answer options:

Intense pain. While managing pain is important, it is not the primary concern during labor induction. Uterine tetany, which can lead to fetal compromise, takes priority over pain management. Pain should be assessed and managed, but it is not the most critical factor Nurse Miller should monitor.

Low blood sugar levels. Low blood sugar (hypoglycemia) is not typically a primary concern during labor induction. It is more relevant in the context of managing patients with diabetes, prolonged labor, or those who have been fasting for an extended period.

Umbilical cord prolapse. Umbilical cord prolapse is a serious obstetric emergency where the umbilical cord slips through the cervix ahead of the fetus. While this is a critical condition, it is not specifically related to labor induction and is more associated with situations involving premature rupture of membranes or abnormal fetal presentation. Nurse Miller should be aware of the signs of umbilical cord prolapse, but it is not as closely linked to labor induction as uterine tetany is.