* Read the article on page 15.
* Take the test, recording your answers in the test answers section (Section B) of the CE enrollment form. Each question has only one correct answer.
* Complete registration information (Section A) and course evaluation (Section C).
* Mail completed test with registration fee to: Lippincott Williams & Wilkins, CE Group, 333 7th Ave, 19th Floor, New York, NY 10001.
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* If you pass, you will receive a certificate of earned contact hours and answer key. If you fail, you have the option of taking the test again at no additional cost.
* A passing score for this test is 13 correct answers.
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Registration Deadline: February 28, 2014
Lippincott Williams & Wilkins (LWW), the publisher of The Journal of Perinatal and Neonatal Nursing, will award 2.5 contact hours for this continuing nursing education activity.
Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
LWW is also an approved provider of continuing nursing education by the District of Columbia, Florida #FBN2454. This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 2.5 contact hours. Your certificate is valid in all states.
The ANCC's accreditation status of Lippincott Williams & Wilkins Department of Continuing Education refers only to its continuing nursing educational activities and does not imply Commission on Accreditation approval or endorsement of any commercial product.
The authors have disclosed that they have no significant relationship with or financial interest in any commercial companies that pertain to this educational activity.
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CE TEST QUESTIONS
General Purpose: To provide registered professional nurses with an understanding of a low-dose oxytocin administration protocol and management of associated outcomes.
Learning Objectives: After reading this article and taking this test, you should be able to:
1. Describe the pharmacokinetics of and potential adverse effects from oxytocin administration.
2. Outline a low-dose oxytocin protocol and the management of adverse effects from the drug.
1. One of the leading causes of obstetrical liability claims involves oxytocin-caused
a. postpartum hemorrhage.
b. hypertensive episodes.
d. pelvic hematoma.
2. With high-alert medications, the most common type of adverse event that occurs is related to
3. What is the half-life of oxytocin?
a. 2 to 3 minutes
b. 4 to 6 minutes
c. 10 to 12 minutes
d. 14 to 16 minutes
4. How many half-lives are required to achieve steady state concentration of oxytocin?
a. 1 to 2
b. 3 to 5
c. 6 to 8
d. 9 to 10
5. Uterine response would be notable how long after the steady state of oxytocin is achieved?
a. 5 to 10 minutes
b. 15 to 20 minutes
c. 30 to 60 minutes
d. 80 to 90 minutes
6. As noted by Simpson and James (2008), persistent increased uterine activity causes
a. Category I fetal heart rate tracings.
b. a decrease in umbilical artery PCO2 levels.
c. fetal alkalemia.
d. a steady decline in fetal oxygen saturation.
7. In the protocol described in this article, prerequisites for oxytocin administration include all of the following except
a. terbutaline readily available.
b. verification of funis presentation.
c. an available labor and delivery nurse.
d. a physician with cesarean section privileges readily available.
8. Which mixture of oxytocin creates a concentration of 1 milliunit (mU) oxytocin equaling 1 mL/h?
a. 10 units of oxytocin/250 mL of intravenous (IV) fluid
b. 20 units of oxytocin/500 mL of IV fluid
c. 30 units of oxytocin/500 mL of IV fluid
d. 40 units of oxytocin/1000 mL of IV fluid
9. According to the protocol, incremental doses of 1 to 2 mU/min can be given every
a. 5 to 10 minutes.
b. 12 to 15 minutes.
c. 20 to 25 minutes.
d. 30 to 60 minutes.
10. The maximum oxytocin dose in the protocol without bedside assessment and an additional order by the provider is
a. 20 mU/min.
b. 30 mU/min.
c. 40 mU/min.
d. 50 mU/min.
11. What is the goal for the number of moderate to strong contractions per palpation in a 10-min period?
a. 1 to 2
b. 3 to 4
c. 5 to 6
d. 7 to 8
12. Treatment of uterine tachysystole in active labor with a Category I fetal heart rate includes
a. discontinuing oxytocin.
b. performing intrauterine resuscitation measures.
c. decreasing the oxytocin rate.
d. reevaluating in 15 minutes.
13. Patients who have had extended administration of oxytocin should be monitored for signs of water intoxication including
14. Signs and symptoms of impending or actual uterine rupture include all of the following except
a. sudden cessation of pain.
b. abdominal rigidity.
c. loss of station.
d. suprapubic pain.
15. Which of the following is included in the patient education handout regarding oxytocin?
a. the low-dose protocol
b. infusion duration
c. treatment of potential adverse effects
d. possible alternatives
16. Compared to the time before the oxytocin protocol, the average length of labor postprotocol implementation was
b. 1 hour less.
d. 2 hours less.
17. The overall incidence of tachysystole postimplementation compared with preimplementation was reduced by almost
18. Between preimplementation in 2008 and postimplementation in 2010, the primary cesarean section rate dropped by almost