Question

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues would alert the nurse that the woman is experiencing uterine hyperstimulation (Select all that apply)?

a. Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency
b. Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency
c. Uterine tone <20 mm Hg
d. Uterine tone >20 mm Hg
e. Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern

Answer 1

Uterine hyperstimulation with oxytocin is indicated by uterine contractions lasting more than 90 seconds and occurring less than 2 minutes apart, uterine tone higher than 20 mm Hg, and increased uterine activity with a nonreassuring fetal heart rate and pattern.

Step-by-step explanation:

The nurse would recognize that a woman is experiencing uterine hyperstimulation with oxytocin if the following clinical cues are observed:

• Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency.
• Uterine tone >20 mm Hg.
• Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern.

These signs reflect an abnormal pattern of contractions that may compromise maternal and fetal well-being, requiring immediate medical intervention to manage the risk. During normal labor, uterine contractions should not be excessively long or frequently occurring; they usually start as every 3-30 minutes and last for 20-40 seconds, intensifying toward the end of the labor stage to every 1.5-2 minutes, lasting for about a minute. In contrast, hyperstimulation is indicated by much stronger and more frequent contractions, often leading to very high uterine tone and potentially distressful patterns on the FHR monitor.