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: Calcium gluconate must be readily available whenever magnesium sulfate is administered because it serves as the antidote for magnesium toxicity. Magnesium sulfate depresses neuromuscular transmission and the central nervous system, which can lead to respiratory depression, hypotension, and cardiac arrest if serum levels become excessive. Having calcium gluconate on hand allows for immediate reversal of these life-threatening effects. This is a critical safety measure and therefore a required nursing action.

Choice B rationale: Respiratory status must be assessed at least every hour during magnesium sulfate therapy because respiratory depression is a primary sign of magnesium toxicity. Normal adult respiratory rate is 12 to 20 breaths per minute, and a rate below 12/min is concerning. Magnesium depresses the respiratory center in the medulla, and early recognition of hypoventilation is essential to prevent hypoxia and arrest. Thus, frequent respiratory monitoring is a priority nursing action.

Choice C rationale: Monitoring intake and output is essential because magnesium sulfate is excreted almost entirely by the kidneys. Oliguria, defined as urine output less than 30 mL/hr, increases the risk of magnesium accumulation and toxicity. Careful fluid balance assessment ensures adequate renal clearance and helps prevent complications such as pulmonary edema. Therefore, strict I&O monitoring is a critical nursing responsibility during magnesium sulfate therapy to ensure safe drug metabolism and excretion.

Choice D rationale: Intermittent fetal monitoring is not appropriate in this context. Magnesium sulfate administration and preterm labor with rupture of membranes require continuous fetal monitoring to detect early signs of distress. Intermittent monitoring risks missing decelerations or prolonged bradycardia. Continuous monitoring provides real-time assessment of fetal well-being and is the standard of care in high-risk obstetric situations. Therefore, intermittent monitoring is not a correct action and should not be selected.

Choice E rationale: Supine positioning is contraindicated in pregnancy, especially in the third trimester, because the gravid uterus compresses the inferior vena cava, leading to supine hypotensive syndrome. This decreases venous return, cardiac output, and uteroplacental perfusion, compromising both maternal and fetal oxygenation. The correct position is left lateral recumbent to optimize circulation. Therefore, placing the client supine is unsafe and not an appropriate nursing action in this scenario.

Choice A rationale

The car seat harness straps should be positioned at or slightly below the baby's shoulders when the car seat is installed rear-facing. Positioning the straps above the shoulders could allow the baby to slide up and out of the harness in a crash due to the forces involved, compromising the restraint system's effectiveness and increasing injury risk.

Choice B rationale

The retainer clip, also called the chest clip, must be positioned at the level of the armpits across the center of the chest or sternum, not the abdomen. This critical placement ensures that the harness straps are kept correctly positioned over the baby's shoulders, preventing the straps from slipping off during a collision and maintaining optimal force distribution across the torso.

Choice C rationale

A 45-degree recline angle for a rear-facing car seat is generally recommended to prevent the infant's head from falling forward, which can compromise the airway, particularly in newborns or infants with poor head control. This specific angle is crucial for maintaining a safe and open airway and is often achieved using built-in level indicators on the car seat base.

Choice D rationale

Current safety recommendations advise keeping a child in a rear-facing car seat as long as possible, typically until they reach the maximum weight or height limit allowed by the car seat manufacturer, which often extends well beyond 12 months of age, frequently up to 2 to 4 years of age, for maximum spinal protection.