A nurse is providing education to a client during a prenatal visit. Which of the following medications should the nurse include as contraindicated during pregnancy?

Rationale:

A. Anemia: End-stage kidney disease reduces erythropoietin production by the kidneys, which impairs red blood cell formation in the bone marrow. This often leads to normocytic, normochromic anemia in affected clients.

B. Oliguria: As kidney function declines, urine output diminishes. Oliguria, defined as urine output less than 400 mL/day, is a common clinical feature of advanced kidney failure due to decreased glomerular filtration.

C. Hypotension: Clients with end-stage kidney disease more commonly experience hypertension due to fluid overload and impaired renin-angiotensin-aldosterone regulation. Hypotension may occur during dialysis but is not a typical baseline finding.

D. Bradypnea: Respiratory compensation for metabolic acidosis in kidney disease typically results in tachypnea, not bradypnea. The body increases respiratory rate to blow off excess CO₂ and correct the acid-base imbalance.

E. Edema: Impaired fluid excretion leads to sodium and water retention, resulting in peripheral, facial, or pulmonary edema. This is a hallmark feature of volume overload in chronic kidney disease.

Rationale:

A. Check the label of the medication twice prior to administration: Safe medication practice requires the nurse to check the medication label three times, when retrieving, preparing, and before administering to minimize the risk of medication errors.

B. Use two identifiers to verify the client's identity: Using two patient identifiers, such as name and date of birth, ensures the medication is given to the correct individual. This step is crucial for patient safety and is a core component of safe medication administration practices.

C. Document administration of the client's routine medications at the beginning of the shift: Medications should only be documented after they have been administered. Pre-charting medication administration can lead to errors if the medication is delayed, omitted, or refused.

D. Ensure the medication is administered within 3 hr of the scheduled time: Medications are typically required to be administered within 30 minutes to 1 hour of the scheduled time unless otherwise specified. A 3-hour window is too broad and may compromise therapeutic effectiveness.