CNM Certified Nurse Midwife

Category - Intrapartum

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A nurse midwife conducts an amniotomy on a client to induce labor. Which of the following interventions is the priority of the nurse midwife after the procedure?

Administer oxygen.
Obtain the client’s blood pressure.
Assess the fetal heart tone.
Position the client in knee-chest position.

Explanation

Answer: C - The priority action of the nurse after an amniotomy is to assess the fetal heart tone. After the escape of the amniotic fluid, the fetus is at risk of cord prolapse, which may result in brain damage. A decrease in the fetal heart tone suggests cord prolapse. Oxygen is administered and the client is placed in knee-chest position if cord prolapse is present.

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CNM Certified Nurse Midwife

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