A nurse is reviewing the medical record of a client who is requesting an oral contraceptive for birth control.
The nurse should identify which of the following findings as a contraindication for the use of oral contraceptives for this client?

Choice A rationale: Verifying that the client has signed an informed consent form is essential before initiating cervical ripening with prostaglandins. Dinoprostone insertion is an invasive procedure with potential risks such as uterine tachysystole, fetal distress, or the need for cesarean delivery. Informed consent ensures that the client understands the risks, benefits, and alternatives, and it fulfills both ethical and legal requirements. Therefore, this intervention must be included in the plan of care prior to medication administration.

Choice B rationale: Terbutaline, a beta-adrenergic agonist, must be readily available because prostaglandins can cause uterine tachysystole or hyperstimulation, which compromises uteroplacental blood flow and fetal oxygenation. Terbutaline relaxes uterine smooth muscle, reversing hyperstimulation and preventing fetal hypoxia. Having this medication immediately accessible is a critical safety measure during induction. This aligns with the provider’s order to notify for tachysystole or nonreassuring FHR and ensures rapid intervention if complications arise.

Choice C rationale: Maintaining bed rest for 2 hours after prostaglandin administration is not recommended. The correct evidence-based practice is to keep the client in a side-lying or supine position with a wedge for 30 to 60 minutes to allow absorption of the medication and reduce the risk of expulsion. Prolonged bed rest beyond this period is unnecessary and increases the risk of venous thromboembolism. Therefore, this intervention is not appropriate for the plan of care.

Choice D rationale: Dinoprostone (Cervidil, Prepidil) is a prostaglandin E2 analog that requires refrigeration to maintain stability and potency. The medication should be kept refrigerated until just before administration to ensure effectiveness. Improper storage at room temperature for extended periods can degrade the drug, reducing its efficacy in cervical ripening. Therefore, refrigeration until administration is a correct nursing intervention and should be included in the plan of care.

Choice E rationale: Assisting with an amniotomy before prostaglandin placement is not appropriate. Prostaglandins are used to ripen the cervix before oxytocin induction, and amniotomy is typically performed later to augment labor once the cervix is favorable. Performing an amniotomy prematurely increases the risk of infection, cord prolapse, and fetal distress. Since the membranes are intact and the cervix is closed and thick, prostaglandin ripening is indicated first, not amniotomy.

Choice F rationale: Keeping calcium gluconate at the bedside is necessary when administering magnesium sulfate, not prostaglandins. Calcium gluconate is the antidote for magnesium toxicity, which causes respiratory depression and cardiac complications. Since this client is not receiving magnesium sulfate, calcium gluconate is not relevant to the current plan of care. Therefore, this intervention is not appropriate in this context.

Choice G rationale: Having the client void before insertion of the prostaglandin is correct. An empty bladder reduces the risk of bladder injury during insertion, improves maternal comfort, and prevents urinary retention while the client remains in the side-lying position for 30 to 60 minutes after administration. This intervention is specifically ordered by the provider and is a standard nursing action to optimize safety and comfort during cervical ripening.

Choice A rationale

Methylergonovine is an uterotonic agent that acts on the smooth muscle of the uterus to stimulate strong, sustained contractions, which are essential for compressing the intramyometrial blood vessels and achieving hemostasis to stop postpartum hemorrhage, especially from uterine atony.

Choice B rationale

While oxygen is important for hypoxia secondary to blood loss, administering it at 2 L/min via nasal cannula is typically insufficient for a client experiencing significant hemorrhage. High-flow oxygen, such as 10 to 15 L/min via nonrebreather mask, is usually required to maximize oxygen saturation.

Choice C rationale

Starting an IV bolus of Dextrose 5.

Choice D rationale

The knee-chest position is generally used to relieve cord compression or help with the manual rotation of the fetus, but it is not an established intervention for managing postpartum hemorrhage. The client should be positioned flat with legs elevated to promote venous return and manage shock.