A nurse is caring for a female client following an emergency cesarean birth in the postpartum unit.

Based on the 0715 assessment findings, the nurse identifies that the client is at greatest risk for developing

_________

and

________

.

Administering methotrexate for ectopic pregnancy requires applying knowledge of chemotherapy safety and pharmacology. The nurse must prioritize hazardous drug handling protocols to protect themselves from chemical exposure while understanding the systemic effects and necessary patient education regarding the medication’s mechanism and lifestyle modifications.

Choice A rationale: Methotrexate is an antimetabolite that can cause gastrointestinal side effects like nausea or stomatitis, but it does not typically cause dark-colored stools. Dark stools are more commonly associated with iron supplementation or upper gastrointestinal bleeding, which is not a standard expectation.

Choice B rationale: Methotrexate is a hazardous chemotherapeutic agent and a known teratogen. According to NIOSH guidelines, nurses must use double-gloving and other personal protective equipment when handling such medications to prevent skin absorption and occupational exposure to the cytotoxic chemicals.

Choice C rationale: For the treatment of an ectopic pregnancy, methotrexate is typically administered as an intramuscular injection to ensure reliable systemic absorption and efficacy in halting the growth of trophoblastic tissue. Subcutaneous administration is not the standard route for this specific obstetric indication.

Choice D rationale: While methotrexate can be found in vaginal secretions, the standard instruction for a patient undergoing treatment for an ectopic pregnancy is to avoid sexual intercourse entirely until the human chorionic gonadotropin levels are undetectable to prevent potential tubal rupture.

Choice A rationale

Uterine contractions every 15 minutes are characteristic of the latent phase of labor, not the active phase. In the active phase, contractions typically become stronger, more frequent, and more regular, occurring every 2 to 5 minutes, signifying progressive cervical dilation.

Choice B rationale

A fetal heart rate (FHR) baseline of 166/min with minimal variability is concerning. While a baseline up to 160/min is generally normal, 166/min is slightly elevated, and minimal variability (5 bpm or less) can indicate fetal hypoxia or acidosis, necessitating further assessment and intervention. Normal FHR baseline is 110-160 bpm.

Choice C rationale

Late decelerations in FHR are non-reassuring findings indicative of uteroplacental insufficiency, meaning inadequate oxygen transfer to the fetus. These decelerations suggest potential fetal distress and require immediate intervention and reporting to the provider, not an expected finding in active labor.

Choice D rationale

Contraction duration of 75 seconds is an expected finding in the active phase of labor. During this phase, contractions typically last 45 to 90 seconds. This duration contributes to effective cervical effacement and dilation, signifying adequate uterine activity for labor progression.