RN Nursing · Labor and Delivery · Practice question
The nurse is caring for a primigravida client who has come in for induction of labor at 41 weeks gestation. The orders from the healthcare provider are for a oxytocin induction. During the assessment, the nurse completes a sterile vaginal exam and the findings are 2/40%/-3, with a Bishop score of 3. What should the nurse do based on these findings?
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The cervix is favorable (ripe) and oxytocin should be started as ordered.
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The cervix is not favorable (not ripe) and the client should be sent home.
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The cervix is favorable (ripe) and the client is in labor.
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✓
The cervix is not favorable (not ripe) and should recommend a prostaglandin to the provider.
Answer & explanation
Correct: The cervix is not favorable (not ripe) and should recommend a prostaglandin to the provider.
The Bishop score is a standardized pre-labor cervical assessment tool used to determine whether the cervix is favorable (ripe) for induction. A Bishop score of 8 or higher in a nullipara indicates cervical ripeness and predicts successful induction. A Bishop score of 6 or more in a multipara is considered favorable. This client is primigravida with a Bishop score of 3, which is low and indicates an unfavorable, unripe cervix. The vaginal exam findings of 2 cm dilation, 40% effacement, and a fetal station of -3 further confirm that the cervix is not ready for oxytocin induction. Proceeding with oxytocin on an unfavorable cervix increases the risk of failed induction, prolonged labor, and cesarean delivery. The appropriate clinical action is to recommend cervical ripening with a prostaglandin agent (such as misoprostol or dinoprostone) before initiating oxytocin. Sending the client home is not appropriate given she is at 41 weeks gestation and has a provider order for induction. The cervical findings do not indicate active labor, so stating that the client is already in labor is incorrect. Recommending prostaglandin ripening to the provider reflects safe, evidence-based practice.
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