A nurse is assessing a client who is 6 hours postpartum, tachycardic, and has cool skin. The client reports that they have been bleeding excessively.
Which of the following actions should the nurse take?

Choice A rationale

Group B Streptococcus (GBS) colonization in a pregnant client does not typically necessitate a cesarean birth. The primary concern with GBS is the risk of vertical transmission to the neonate during vaginal birth, which can lead to severe neonatal infections like sepsis, meningitis, or pneumonia. Cesarean section is generally reserved for obstetric indications and does not eliminate the risk of GBS transmission if membranes rupture.

Choice B rationale

Intravenous antibiotic prophylaxis is the cornerstone of preventing neonatal GBS disease in colonized mothers. The recommended antibiotics, typically penicillin or ampicillin, are administered during labor once ruptured membranes or active labor commence. This intrapartum treatment significantly reduces bacterial colonization in the birth canal, thereby minimizing the neonate's exposure to the bacteria during passage.

Choice C rationale

A vaginal culture for GBS is typically performed between 36 and 37 weeks of gestation as part of routine prenatal screening. If the client has already been screened and identified as GBS positive at 36 weeks, repeating the culture during active labor is not indicated as the colonization status is already known, and the focus shifts to prophylaxis.

Choice D rationale

Metronidazole is an antibiotic primarily effective against anaerobic bacteria and certain parasites. It is not the drug of choice for Group B Streptococcus prophylaxis. Penicillin or ampicillin are the preferred antibiotics for GBS intrapartum prophylaxis due to their effectiveness against GBS and their favorable safety profile for both the mother and the fetus.

Choice A rationale

Methotrexate primarily affects rapidly dividing cells and can cause gastrointestinal side effects, but dark-colored stools are not a commonly expected adverse effect. Dark stools might indicate gastrointestinal bleeding, which would be a concerning symptom requiring immediate investigation, not a typical drug effect.

Choice B rationale

Methotrexate is a hazardous drug classified as a chemotherapy agent. Nurses must wear appropriate personal protective equipment, including two pairs of gloves, when preparing and administering this medication to prevent skin exposure and absorption, which can lead to systemic toxicity due to its cytotoxic properties.

Choice C rationale

Methotrexate for ectopic pregnancy is typically administered intramuscularly, not subcutaneously. Intramuscular administration ensures systemic absorption and distribution to target rapidly dividing trophoblastic cells. Subcutaneous injection would not provide adequate drug delivery for this indication and may lead to localized reactions.

Choice D rationale

Methotrexate is a teratogenic medication, meaning it can cause birth defects. To prevent fetal exposure and potential harm, clients are advised to avoid pregnancy during and for a period after treatment. Using barrier contraception like condoms for at least 7 days, or longer as advised, is crucial to prevent conception and protect a potential fetus.