A nurse is teaching a client who is at 14 weeks of gestation about expected body changes during pregnancy.
Which of the following manifestations should the nurse include in the teaching?

Choice A rationale

While seizures are a serious adverse effect of ergot alkaloids, they are primarily associated with the most severe form of ergotism, which is an overdose or prolonged exposure, or in clients with severe preeclampsia/eclampsia. Methylergonovine's more common and immediate adverse effect is its potent vasoconstrictive property, leading to elevated blood pressure.

Choice B rationale

Methylergonovine is an ergot alkaloid that acts as a potent vasoconstrictor and smooth muscle contractor, primarily on the uterus to treat postpartum hemorrhage and uterine atony. Its generalized vasoconstrictive effect, however, can lead to a significant elevation in blood pressure, making hypertension (blood pressure greater than 140/90 mmHg or an increase of 20 mmHg or more) a major and frequent adverse effect.

Choice C rationale

Methylergonovine's potent vasoconstrictive action typically causes an increase in peripheral vascular resistance, which often results in bradycardia (heart rate less than 60 beats/min) as a reflex response to the elevated blood pressure. Tachycardia (heart rate greater than 100 beats/min) is not a typical adverse effect of this medication.

Choice D rationale

Methylergonovine acts mainly on the smooth muscle of the uterus and blood vessels; it does not typically cause water retention. Water retention is more commonly associated with conditions like preeclampsia or medications such as glucocorticoids. The adverse effects of methylergonovine center around vasoconstriction and uterine cramping.

Choice A rationale

Nausea is a very common, generally mild, and often transient side effect of oral contraceptives, usually caused by the estrogen component. It typically improves over a few cycles as the body adjusts to the hormonal changes and does not usually necessitate immediate notification of the healthcare provider.

Choice B rationale

Abdominal bloating is a frequent and minor adverse effect of hormonal contraception, often related to fluid retention or altered gastrointestinal motility due to hormonal fluctuation, which is usually self-limiting or manageable with minor adjustments, thus not requiring urgent reporting.

Choice C rationale

Breast tenderness or mastalgia is a common, dose-related side effect linked to hormonal stimulation (estrogen and/or progestin) of the mammary tissue, similar to premenstrual symptoms, and is generally considered a nuisance rather than an immediate danger sign.

Choice D rationale

Persistent headaches, especially if severe, unilateral, or associated with visual changes, can be a symptom of a serious adverse event like a cerebrovascular accident (stroke) or thrombotic events (e.g., cerebral venous thrombosis), which are rare but serious risks associated with hormonal contraceptives, necessitating immediate medical evaluation.