A nurse is providing discharge teaching to a client who has GERD.
Which of the following information should the nurse include?

Choice A rationale

A dosimeter is used to measure the amount of radiation exposure for the healthcare professional, not the client. It is a personal radiation-monitoring device that provides a record of an individual's accumulated dose of ionizing radiation. Attaching a dosimeter to the client's gown is an inappropriate intervention as the client is the source of the radiation, and the dosimeter is designed to protect the healthcare worker by monitoring their exposure.

Choice B rationale

Brachytherapy involves placing a radioactive source close to the tumor. To minimize the radiation exposure of others, a safe distance is maintained. A distance of at least 1 meter (3.3 feet) from the source of radiation is a standard safety measure for visitors and healthcare staff. This inverse square law principle of radiation safety dictates that intensity decreases with the square of the distance from the source, so increasing distance significantly reduces exposure.

Choice C rationale

When a client is undergoing brachytherapy, it is essential to limit the amount of time visitors spend in close proximity. The typical time limit for visitors is 30 minutes per day, not 2 hours. This is a crucial radiation safety measure that adheres to the principle of "Time, Distance, and Shielding.”. Limiting the time of exposure directly reduces the total radiation dose received by the visitor, thereby minimizing potential harm from the radiation source.

Choice D rationale

For a client undergoing brachytherapy, there is a risk that the radioactive implant could be dislodged and expelled from the body. Therefore, straining the client's urine is a critical intervention. This allows the nurse to inspect for and retrieve the implant if it has been inadvertently expelled, ensuring it is not lost and that appropriate safety protocols for handling radioactive materials are followed. This also prevents potential radiation exposure to others. *.

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. *.