A nurse is caring for a client who is in the latent phase of labor and reports severe back pain. The vaginal examination reveals that the cervix is dilated 2 cm, 25% effaced, and -2 station.
Which of the following interventions should the nurse implement?

Choice A rationale

Drowsiness is a symptom of hypothyroidism, not hyperthyroidism (thyrotoxicosis). Levothyroxine is a synthetic thyroid hormone used to treat hypothyroidism. An overdose or excessive dose of this medication would lead to symptoms of hyperthyroidism, which is the opposite of drowsiness. Instead, clients would likely experience increased energy levels, anxiety, or insomnia.

Choice B rationale

Weight gain is a classic symptom of hypothyroidism, not thyrotoxicosis. When the body's metabolism slows down due to insufficient thyroid hormone, the client may gain weight. A client experiencing thyrotoxicosis from an excessive dose of levothyroxine would typically exhibit a hypermetabolic state, which often leads to unintended weight loss despite an increased appetite.

Choice C rationale

A fever is a sign of an accelerated metabolic rate, which is a key feature of thyrotoxicosis. When thyroid hormone levels become excessively high, the body's basal metabolic rate increases significantly, causing an increase in body temperature. This can manifest as a low-grade fever or even a significant fever in severe cases, requiring immediate medical attention.

Choice D rationale

Bradycardia, or a slow heart rate, is a symptom of hypothyroidism. The heart rate slows down as the body's overall metabolic processes decrease. Thyrotoxicosis is characterized by a rapid heart rate, known as tachycardia. This is due to the excessive stimulation of the cardiovascular system by high levels of thyroid hormone. A normal heart rate is typically between 60 and 100 beats per minute. .

Choice A rationale

Postterm pregnancy, defined as a gestation extending beyond 42 weeks, is not a contraindication for misoprostol. In fact, it is a common indication for labor induction, as the placenta may begin to deteriorate, increasing the risk of fetal distress and meconium aspiration. Misoprostol, a prostaglandin E1 analog, helps ripen the cervix and stimulate uterine contractions. This pharmacologic action is beneficial in initiating labor in postterm pregnancies.

Choice B rationale

Transverse fetal lie is an obstetrical position where the fetus is lying sideways across the uterus. This position poses a significant risk of complications during vaginal birth, including uterine rupture and umbilical cord prolapse. Therefore, any attempt to induce labor with a medication like misoprostol is contraindicated. Cesarean delivery is typically the preferred method of delivery in cases of persistent transverse lie to ensure a safe delivery for both mother and fetus.

Choice C rationale

Intrauterine growth restriction (IUGR) is a condition where a fetus is smaller than expected for gestational age. It is not a contraindication for misoprostol. Often, IUGR is an indication for labor induction to prevent further fetal compromise. Misoprostol is a commonly used medication for this purpose, as it helps to initiate cervical ripening and uterine contractions, which can lead to a successful vaginal delivery.

Choice D rationale

A history of a cesarean section is a significant contraindication for misoprostol because it substantially increases the risk of uterine rupture. Misoprostol causes potent uterine contractions that can place undue stress on the uterine scar from the previous surgery. The risk of rupture is a life-threatening complication for both the mother and the fetus. Therefore, other methods of labor induction or a planned repeat cesarean section are often considered. *.