A primigravida at 41 weeks gestation is admitted for labor induction due to post-term pregnancy. The cervix is 1 cm dilated, 50% effaced, and the fetal head is at -2 station. Which nursing intervention should be the priority when preparing for cervical ripening with misoprostol (Cytotec)?

With an unfavorable cervix (Bishop score less than 6), cervical ripening with prostaglandins like misoprostol is indicated before oxytocin induction to improve cervical readiness for labor.

Correct Answer: 4. Obtain informed consent and ensure continuous fetal monitoring is established

Rationale:

This question addresses the critical nursing priorities before initiating cervical ripening with misoprostol (Cytotec). The scenario presents a post-term pregnancy at 41 weeks gestation with an unfavorable cervix (1 cm dilated, 50% effaced, -2 station), which is a common indication for pharmacological cervical ripening.

The priority nursing intervention is to obtain informed consent and establish continuous fetal monitoring. This is grounded in two fundamental principles of safe nursing practice. First, misoprostol is a prostaglandin E1 analog that promotes cervical ripening and stimulates uterine contractions. A known and serious risk of this medication is tachysystole (excessive uterine contractions), which can lead to non-reassuring fetal heart rate patterns and fetal compromise. The research by Eminov and Eminov (2025) specifically investigates the safety of misoprostol administration, highlighting that the evaluation of adverse events, including uterine hyperstimulation, is a core component of comparing induction agents ^[1]. Therefore, a baseline assessment of fetal well-being and continuous monitoring to detect abnormalities immediately after administration are non-negotiable safety requirements. Second, as an invasive pharmacological intervention with known risks, the patient has the ethical and legal right to be fully informed about the procedure, its purpose, potential side effects, and alternative options before it is performed. The nurse's role is to verify that this consent has been obtained and documented.

The other options are incorrect because they bypass these critical safety steps. Administering the medication immediately without consent or establishing monitoring is a violation of patient rights and a safety risk. Inserting an intrauterine pressure catheter (IUPC) is an invasive procedure typically reserved for situations where external monitoring is inadequate, not a standard prerequisite for cervical ripening. Preparing for an immediate cesarean delivery is an extreme and inappropriate response to an unfavorable cervix; the entire purpose of cervical ripening is to improve the Bishop score to facilitate a vaginal delivery, a principle supported by the study from Zheng et al. (2026), which examines misoprostol’s role in improving the cervical Bishop score to achieve a successful vaginal birth .