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 for Correct Choices

• Intravenous antibiotics: The client presents with uterine tenderness, dark foul-smelling lochia, a mildly elevated temperature, and an elevated WBC count, all of which point to endometritis, a common postpartum infection. The first-line treatment for endometritis is broad-spectrum IV antibiotics to prevent complications like sepsis.
• Increase in daily fluid intake: Infection and fever can increase fluid loss through insensible means, and fluids support circulation, renal function, and antibiotic delivery. Encouraging increased fluid intake also helps address dehydration from fever and supports healing and lactation.

Rationale for Incorrect Choices

• Kleihauer-Betke test: This test detects fetal-to-maternal hemorrhage and is used in trauma or suspected placental abruption in Rh-negative mothers. There is no indication of bleeding or Rh incompatibility in this case, so it is not appropriate here.
• Tocolytic medication: Tocolytics are used to suppress uterine contractions in preterm labor. This client is postpartum and has no signs of preterm labor or uterine hyperstimulation, so this medication is not warranted.
• Intrauterine tamponade balloon: This device is used for severe postpartum hemorrhage due to uterine atony that doesn’t respond to medical treatment. The client has moderate lochia but no signs of active hemorrhage or hemodynamic instability, so it is not indicated.

Rationale:

A. Acetaminophen: Acetaminophen is generally considered safe during pregnancy when used at recommended doses. It is commonly used to treat mild pain and fever without significant risk to the fetus.

B. Saline nasal spray: Saline nasal sprays are non-medicated and safe for use during pregnancy. They help relieve nasal congestion without systemic absorption or risk to fetal development.

C. Levothyroxine: Levothyroxine is a thyroid hormone replacement that is safe and essential during pregnancy for clients with hypothyroidism. Untreated hypothyroidism poses greater risks to both mother and fetus than the medication itself.

D. Ibuprofen: Ibuprofen is contraindicated, especially during the third trimester, due to risks such as premature closure of the ductus arteriosus, oligohydramnios, and delayed labor. Acetaminophen is preferred for pain relief in pregnancy.