A nurse caring for a patient receiving oxytocin therapy suddenly is experiencing hypertonic contractions. Which of the following priority nursing actions should the nurse do? Select all that apply.
A. The nurse leaves the client to ask for help.
B. Administer oxygen at 8 to 10 liters per minute.
C. Stop the oxytocin infusion.
D. Place the client in the supine position.
E. Increase the flow rate of the intravenous additive solution.
Correct Answer: B, C, & E.
The presence of hypertonic contractions indicates the need to initiate emergency measures. The oxytocin infusion must be stopped to reduce uterine stimulation, administering oxygen will promote increased fetal and maternal oxygenation.
Option A: The nurse should stay with the client.
Option D: Placing the client in a supine position will not promote an increase in placental oxygenation.