A 40-week gravida presents with cervical dilation of 6 cm and uterine contractions every 5 minutes. What is the appropriate next nursing action?

1. A

   Administer oxytocin injection now

2. B

   Instruct to begin pushing

3. C

   Perform fundal massage

4. D

   Continue monitoring labor progress and fetal status

Appeared in: NORCET 9 Mains - 2025

Explanation

Listen in Hindi

• The patient's clinical presentation (6 cm cervical dilation, regular contractions) places her in the active phase of the first stage of labor.
• Standard evidence-based practice for a normally progressing active labor is to closely monitor maternal and fetal parameters without immediate intervention.
• This approach, often called 'watchful waiting,' respects the physiological process of birth and avoids the risks associated with unnecessary medical procedures.
• Key monitoring includes assessing contraction patterns, fetal heart rate, maternal vital signs, and the rate of cervical change over time.

Why Other Options Were Wrong

• Option A: Oxytocin is used for labor augmentation when contractions are inadequate or labor has stalled (arrested). There is no indication of labor dystocia in this scenario.
• Option B: Pushing begins in the second stage of labor, which starts only when the cervix is fully dilated to 10 cm.
• Option C: Fundal massage is a postpartum intervention used to stimulate uterine contraction after the placenta is delivered to prevent hemorrhage.

Related Visual

• Visual 1: Chart - A table illustrating the stages and phases of labor, including cervical dilation, contraction patterns, and key nursing priorities for each, would be highly beneficial for learners.
• Visual 2: Diagram - A series of diagrams showing the progression of cervical dilation from 0 to 10 cm to help visualize the different phases of the first stage of labor.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Nursing management during the active phase of the first stage of labor to guide bedside assessment, documentation, and the next nursing action.
• Understanding the stages of labor and the appropriate interventions for each is fundamental to safe and effective obstetric nursing.
• Avoiding unnecessary interventions, such as premature administration of oxytocin or instructing to push too early, is a key patient safety principle that helps prevent complications like uterine hyperstimulation, fetal distress, and cervical trauma.
• A nurse's role is to support the natural labor process while vigilantly monitoring for deviations from the norm that require intervention.

How to Approach the Question

• First, analyze the clinical data provided in the question: gestational age (40 weeks), cervical dilation (6 cm), and contraction frequency (every 5 minutes).
• Based on this data, identify the stage and phase of labor. A dilation of 6 cm indicates the active phase of the first stage of labor.
• Recall the standard nursing management and priorities for the active phase of labor.
• Evaluate each option against the standard of care for this specific phase.
• Eliminate options that are inappropriate for the active phase: 'pushing' is for the second stage, 'fundal massage' is for the fourth stage (postpartum), and 'oxytocin' is for induction or augmentation, not routine active labor.
• Select the option that aligns with the primary nursing role in this phase, which is monitoring and assessment.

Concept Tested & Keywords

• Concept Tested: Nursing management during the active phase of the first stage of labor.
• Stem keywords: 40-week gravida, cervical dilation of 6 cm, uterine contractions every 5 minutes, nursing action
• Lead-in keywords: appropriate next
• Clinical cues: Cervical dilation of 6 cm signifies the patient is in the active phase of labor.
• Clinical cues: Regular contractions every 5 minutes indicate established labor.

Question ID

QJ_01nUZdPdob-9tPWtAmc

Copy ID