A nurse is assisting in the care of a client who is at 36 weeks of gestation and is in preterm labor. The nurse should expect a prescription for which of the following medications for the client?

Rationale:

• Contact the provider for an antibiotic prescription: Contacting the provider ensures the client receives prompt intervention for a likely surgical site infection. The wound is inflamed and draining yellow pus, and the client has a fever and leukocytosis. Early treatment can prevent the progression to severe sepsis.

• Increase the volume on the television: Increasing the volume on the television can heighten sensory overload and worsen the client’s confusion. Delirium management involves reducing noise and visual stimuli, not adding to it. This approach does not promote orientation or calmness.

• Ask the client's partner to leave the room: Asking the client's partner to leave may remove a critical source of comfort and familiarity. Familiar people help reorient clients with delirium or confusion. Their presence often reduces agitation and promotes emotional security.

• Dim the lights: Dimming the lights reduces environmental overstimulation that may worsen delirium. The client is experiencing hallucinations and disorientation, which are often intensified in bright ICU settings. A calm setting supports cognitive clarity and comfort.

• Assist with elimination: Assisting with elimination is appropriate if the client shows signs of distress or discomfort. However, this need is not emergent compared to infection and altered mental status. Treating the underlying cause of delirium should take precedence.

• Place the client in 4-point restraints: Placing the client in 4-point restraints is a last resort when other safety measures fail. Restraints can escalate agitation and lead to injury or trauma. Delirium should be managed first with environmental and medical interventions.

Rationale:

A. Headaches with aura: Headaches accompanied by aura are a strong contraindication to oral contraceptive use due to the significantly increased risk of thromboembolic events, particularly ischemic stroke. Estrogen-containing contraceptives can further exacerbate this vascular risk, making alternative forms of birth control necessary.

B. Gastroesophageal reflux disease: GERD is a gastrointestinal condition that does not affect the safety or efficacy of oral contraceptives. Although hormonal fluctuations can sometimes influence gastric symptoms, GERD is not a contraindication to contraceptive use.

C. History of mononucleosis 1 year ago: A past infection with mononucleosis does not impact liver function long-term in most cases and does not interfere with hormonal contraceptive use. It does not pose any increased risk related to estrogen or progesterone components.

D. Irregular menstrual cycles: While irregular cycles are a common reason for initiating oral contraceptives, they are not a contraindication. In fact, hormonal contraceptives are often used therapeutically to regulate menstrual patterns and reduce cycle variability.