Which medical condition would warrant a prescription for high-dose corticosteroids?

Choice A rationale:

Oxytocin is a hormone that stimulates uterine contractions. It is not a tocolytic, which is a medication that inhibits uterine contractions. In fact, oxytocin is often used to induce labor or to augment labor that is progressing slowly.

It acts on the myofibrils in the uterine muscle, causing them to contract more forcefully and frequently. This leads to cervical dilation and effacement, and ultimately to the birth of the baby.

Oxytocin is typically administered as an intravenous (IV) infusion. The dosage is carefully titrated to achieve the desired effect on the uterus.

It is important to note that oxytocin can have serious side effects, including uterine hyperstimulation, fetal distress, and postpartum hemorrhage. Therefore, it should only be used under the close supervision of a healthcare provider.

Choice B rationale:

Magnesium sulfate is a tocolytic that is often used to prevent preterm labor. It works by relaxing the smooth muscle of the uterus.

It is typically administered as an IV infusion. The dosage is carefully monitored to ensure that the magnesium level in the blood does not become too high.

Side effects of magnesium sulfate can include flushing, nausea, vomiting, and headache. In rare cases, it can also cause serious complications such as respiratory depression and cardiac arrest.

Choice C rationale:

Nifedipine is a calcium channel blocker that is sometimes used as a tocolytic. It works by relaxing the smooth muscle of the uterus and blood vessels.

It is typically administered as an oral tablet. Side effects of nifedipine can include headache, dizziness, flushing, and low blood pressure.

Choice D rationale:

Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that is sometimes used as a tocolytic. It works by inhibiting the production of prostaglandins, which are substances that promote uterine contractions.

It is typically administered as an oral tablet or suppository. Side effects of indomethacin can include nausea, vomiting, heartburn, and diarrhea.

Rationale for Choice A:

Decreasing the morning insulin dose by half without consulting the provider could lead to hyperglycemia, which can be dangerous for patients with diabetes, especially those undergoing surgery.

It is important to individualize insulin doses based on the patient's blood glucose levels, insulin sensitivity, and other factors. The provider may need to assess the patient's blood glucose levels and adjust the insulin dose accordingly.

Rationale for Choice B:

It is not safe to assume that the provider would want the client to receive the usual insulin dose prior to surgery without confirming this with the provider.

Patients with diabetes who are NPO (nothing by mouth) are at risk for hypoglycemia, as they are not receiving their usual intake of carbohydrates.

It is important to adjust insulin doses to prevent hypoglycemia in these patients.

Rationale for Choice D:

Holding the morning dose of insulin until after a fasting glucose is done could lead to hyperglycemia, as the patient would not be receiving any insulin to cover their blood glucose levels.

It is important to administer insulin to patients with diabetes, even if they are NPO, to prevent hyperglycemia.

Rationale for Choice C:

This is the best action for the nurse to take because it ensures that the provider is aware of the situation and can provide appropriate orders for the patient's insulin management.

The provider may need to adjust the insulin dose, order a fasting glucose level, or provide other instructions for the patient's care.

It is important to communicate with the provider to ensure that the patient receives safe and appropriate care.