A nurse is assessing a client who is in labor.
Which of the following findings should the nurse expect?

The nurse should anticipate the provider will prescribe terbutaline and betamethasone.

Rationale for correct answers:
Terbutaline is a beta-2 adrenergic agonist that relaxes uterine smooth muscle by increasing intracellular cyclic AMP, reducing calcium influx, and thus inhibiting contractions. It is commonly used as a tocolytic to delay preterm labor, allowing time for fetal maturation. Betamethasone is a corticosteroid given to accelerate fetal lung maturity by stimulating surfactant production in the fetal lungs, which significantly reduces the risk of respiratory distress syndrome in neonates born between 24 and 34 weeks gestation. The normal fetal fibronectin level is ≤0.05 mcg/mL; a value above this, as in this client (0.09 mcg/mL), indicates increased risk of preterm birth, supporting the use of these medications.

Rationale for incorrect answers:
Oxytocin (Response 1) stimulates uterine contractions via oxytocin receptors, promoting labor induction or augmentation. Administering oxytocin before term or in preterm labor is contraindicated because it can worsen contractions, precipitating early delivery.

Betamethasone (Response 1) is not used to stop contractions but to promote fetal lung maturity. It does not act as a tocolytic; thus, it is not prescribed alone to delay labor.

Misoprostol (Response 1) is a prostaglandin E1 analog that promotes cervical ripening and uterine contractions, making it inappropriate in preterm labor management, where delaying labor is the goal.

Oxytocin (Response 2) serves no purpose in fetal lung maturation and instead promotes contractions; thus, it is contraindicated here.

Ondansetron (Response 2) is an antiemetic without effects on uterine activity or fetal lung maturity; its use is unrelated to preterm labor management.

Misoprostol (Response 2) induces labor and cervical changes and is contraindicated in preterm labor where prolonging pregnancy is desired.

Take-home points:

• Terbutaline delays preterm labor by relaxing uterine muscles, buying critical time for fetal development.
• Betamethasone accelerates fetal lung maturity by stimulating surfactant production, reducing neonatal respiratory complications.
• Oxytocin and misoprostol induce labor and are contraindicated in preterm labor management aiming to delay delivery.
• Fetal fibronectin levels above 0.05 mcg/mL indicate increased risk of preterm birth, guiding tocolytic and steroid therapy.

Choice A rationale

Tachycardia is a common finding in hyperemesis gravidarum due to fluid volume deficit. Significant and persistent vomiting leads to hypovolemia, which triggers a compensatory increase in heart rate to maintain cardiac output and tissue perfusion. The body attempts to compensate for reduced circulating blood volume by increasing the rate at which blood is pumped.

Choice B rationale

Dry mucous membranes are a direct clinical sign of dehydration, which is a hallmark of hyperemesis gravidarum. Prolonged and severe vomiting leads to significant fluid loss, depleting the body's water content. This desiccation is visibly manifested in the oral cavity as dry and sticky mucous membranes, indicating intracellular and extracellular fluid deficit.

Choice C rationale

Poor skin turgor, characterized by skin that remains tented when pinched, is another objective indicator of dehydration. The loss of interstitial fluid due to excessive vomiting reduces the elasticity and plumpness of the skin. This finding reflects a significant depletion of fluid volume within the subcutaneous tissues.

Choice D rationale

Polyuria, meaning excessive urination, is not a typical finding in hyperemesis gravidarum. Instead, severe vomiting and dehydration would lead to oliguria (decreased urine output) as the kidneys attempt to conserve fluid to compensate for the significant fluid losses. The body's priority is fluid retention.

Choice E rationale

Hypertension is generally not associated with hyperemesis gravidarum. Due to significant fluid loss and dehydration, clients with hyperemesis gravidarum are more likely to experience orthostatic hypotension or even profound hypotension as a result of hypovolemia. The decreased circulating blood volume leads to reduced vascular resistance and blood pressure.