A nurse is caring for a client with postpartum hemorrhage.
The provider has ordered Methylergonovine 200 mcg intravenously to be administered stat. The nurse should perform which priority assessment prior to administering this medication?
Assess the client’s pain scale.
Assess the client’s respiratory rate.
Assess the client’s blood pressure.
Assess the client’s last bowel movement.
The Correct Answer is C
The correct answer is choice C. Assess the client’s blood pressure. Methylergonovine is a uterotonic medication that can cause hypertension and is contraindicated for clients with preeclampsia or cardiac disease.
Therefore, the nurse should check the client’s blood pressure before administering this medication to ensure it is within normal range (120/80 mm Hg or lower).
Choice A is wrong because assessing the client’s pain scale is not a priority assessment before giving methylergonovine.
Pain is not a contraindication for this medication and does not affect its effectiveness.
Choice B is wrong because assessing the client’s respiratory rate is not a priority assessment before giving methylergonovine.
Respiratory rate is not affected by this medication and does not indicate any adverse effects.
Choice D is wrong because assessing the client’s last bowel movement is not a priority assessment before giving methylergonovine.
Bowel movement is not related to postpartum hemorrhage or uterine atony, which are the indications for this medication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is choice B: The risk of transplacental transmission of chlamydia between mother and baby is low.This means that the infection is unlikely to pass from the mother’s blood to the baby’s blood through the placenta.However, this does not mean that the infection is harmless for the baby.
Choice A is wrong because transmission of chlamydia usually occurs when the baby passes through the vagina.This can cause eye infections or pneumonia in the newborn.
Choice C is wrong because the baby has probably not developed antibodies to the chlamydia in utero.Antibodies are proteins that help fight infections, and they are usually passed from the mother to the baby through the placenta.However, chlamydia does not stimulate a strong antibody response in the mother, so there is little protection for the baby.
Choice D is wrong because the baby will not receive systemic treatment at birth to prevent a chlamydia infection.Systemic treatment means medication that affects the whole body, such as oral or intravenous antibiotics.The baby will only receive topical treatment, such as eye drops or ointment, to prevent eye infections.Normal ranges: Chlamydia infection is common among pregnant women, especially those under 25 years old or with risk factors such as multiple or new sexual partners.The prevalence of chlamydia among pregnant women in the United States ranges from 1% to 40%, depending on the population and screening methods.Chlamydia infection can be diagnosed by urine or swab tests, and treated with antibiotics such as azithromycin or doxycycline.Chlamydia screening is recommended for all pregnant women at their first prenatal visit and again in the third trimester if they are at high risk.
Correct Answer is B
Explanation
The correct answer is choice B. The administration route of terbutaline will be changed from intravenous to oral.
This is because terbutaline is a medication that can be used to suppress preterm labor by relaxing the uterine smooth muscle.It can be given subcutaneously or intravenously for acute episodes of preterm labor, but it is not recommended for long-term use due to the risk of serious maternal and fetal adverse effects.Therefore, if the client’s condition stabilizes, the administration route of terbutaline will be changed from intravenous to oral, which has a lower bioavailability and less systemic effects.
Choice A is wrong because terbutaline is not usually self-administered parenterally by the client at home.It requires a trained health professional to give it as a shot under the skin or through a vein.
Choice C is wrong because the client does not need to remain in a private room without visitors until she has been without contractions for 48 hours.
This is an unnecessary restriction that may increase the client’s stress and anxiety.
The client should be encouraged to have social support and emotional comfort during this time.
Choice D is wrong because the client should not ambulate in the hallway after 12 hours without contractions.
This may stimulate uterine activity and cause a recurrence of preterm labor.
The client should follow the provider’s instructions on bed rest and activity limitations.
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