A nurse is assessing a client who is at 8 weeks of gestation and has hyperemesis gravidarum.
Which of the following are findings of this condition? (Select all that apply.)

Choice A rationale: Tocolytic medications such as terbutaline, a beta-2 adrenergic agonist, commonly cause nervous system stimulation, leading to side effects like jitteriness, tremors, and anxiety. This occurs because beta-2 receptor activation increases sympathetic nervous system activity, resulting in heightened neuromuscular excitability. These symptoms are transient and expected during therapy, reflecting systemic beta-2 receptor effects beyond uterine muscle relaxation.

Choice B rationale: Terbutaline and similar beta-2 agonist tocolytics increase heart rate by stimulating beta-adrenergic receptors in cardiac tissue. This causes positive chronotropic effects, increasing the rate of sinoatrial node firing. Tachycardia is a common adverse effect and is closely monitored as excessive cardiac stimulation can precipitate arrhythmias, especially in clients with underlying cardiac conditions.

Choice C rationale: Tocolytics like terbutaline typically do not increase blood pressure; in fact, beta-2 agonists cause vasodilation leading to decreased peripheral vascular resistance and often lower blood pressure. An increase in blood pressure is not a typical pharmacologic effect and would be unusual. Hypertensive responses are more commonly associated with other drug classes, such as alpha-agonists or corticosteroids.

Choice D rationale: The primary pharmacologic goal of tocolytics is to relax uterine smooth muscle by decreasing intracellular calcium levels, thus inhibiting contractions. Terbutaline, as a beta-2 agonist, activates adenylate cyclase increasing cAMP, which reduces contractility. Therefore, a decrease in contraction frequency and intensity is an expected therapeutic outcome.

Choice E rationale: Terbutaline is commonly administered subcutaneously, allowing for rapid absorption and onset of action. The subcutaneous route facilitates outpatient administration and easy titration of doses. Intramuscular or intravenous routes are less frequently used for this medication in preterm labor management. Patient education on injection technique and site care is essential to prevent complications.

Choice F rationale: Headaches can occur as a side effect of tocolytic therapy due to systemic vasodilation and fluid shifts. The medication-induced relaxation of vascular smooth muscle can cause mild cerebral vasodilation, leading to headaches. This side effect is generally manageable but should be monitored to differentiate from more serious adverse reactions.

Choice G rationale: Reflex monitoring is not a standard requirement for beta-2 agonist tocolytics like terbutaline. Reflex checks are more relevant for magnesium sulfate therapy, which can cause neuromuscular blockade and require frequent deep tendon reflex assessments to avoid toxicity. Therefore, frequent reflex monitoring is not indicated with terbutaline.

Choice A rationale

Fetal heart rate (FHR) accelerations occurring with fetal movement signify a healthy autonomic nervous system and adequate fetal oxygenation. These accelerations, typically 15 beats per minute (bpm) above baseline for 15 seconds in a fetus beyond 32 weeks, indicate a reactive nonstress test, reflecting good fetal well-being.

Choice B rationale

Late decelerations are a concerning finding, indicating uteroplacental insufficiency and potential fetal hypoxia. They are characterized by a gradual decrease in FHR that begins after the peak of the contraction and returns to baseline after the contraction ends, signifying a non-reassuring fetal status.

Choice C rationale

Variable decelerations are abrupt decreases in FHR, often indicative of umbilical cord compression. While not always pathological, frequent or severe variable decelerations can compromise fetal oxygenation and require further assessment, thus not indicating a reactive nonstress test.

Choice D rationale

Minimal variability in FHR, defined as an amplitude range of 5 bpm or less, suggests a compromised fetal central nervous system or a sleeping state. Persistent minimal variability can be a sign of fetal hypoxia or acidosis, and it does not meet the criteria for a reactive nonstress test. Normal variability is 6-25 bpm.