A nurse is caring for an adolescent who has heart failure and a prescription for digoxin 125 mcg PO daily. Available is digoxin PO 0.25 mg/tablet. How many tablets should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Rationale:

A. Decrease in amount of lochia and passage of clots is incorrect because ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) and does not affect uterine bleeding or the passage of lochia. Changes in lochia are related to normal postpartum involution of the uterus and not pain medication.

B. Decrease in milk production is incorrect because the client is not breastfeeding, and ibuprofen does not suppress milk production. Milk production is influenced by lactation hormones such as prolactin and oxytocin.

C. Decrease in swelling in the extremities is incorrect because while NSAIDs can reduce inflammation, mild postpartum edema is generally physiologic and not significantly impacted by a single dose of ibuprofen. This outcome is not the primary therapeutic goal in this context.

D. Decrease in discomfort is correct because ibuprofen is administered to relieve postpartum pain, including uterine cramping, perineal discomfort, or musculoskeletal soreness after vaginal birth. Pain relief is the intended effect of the medication, and the nurse should evaluate the client’s reported pain level to determine if the desired outcome has been achieved.

Rationale:

A. Although this client is hemorrhaging with a fetal demise, emergent cesarean delivery is not indicated when the fetus has already died. The priority is maternal stabilization and vaginal delivery if possible. Cesarean section in the presence of fetal demise is reserved for maternal indications only, such as uncontrolled bleeding or uterine rupture, which is not explicitly stated here.

B. This client is at 37 weeks with a category II fetal heart tracing, which indicates fetal compromise, and has incomplete cervical dilation. Placental abruption can rapidly compromise fetal oxygenation. In this scenario, emergent cesarean delivery is indicated to prevent fetal death because vaginal delivery would take too long, and the fetus is showing signs of distress. Maternal vital signs are stable, so the priority is fetal well-being.

C. This client is at 32 weeks but has stable maternal vital signs and a category I fetal heart tracing, indicating no fetal compromise. Immediate cesarean section is not warranted; careful monitoring and supportive care are appropriate. Delivery may be planned based on gestational age, maternal stability, and severity of abruption.

D. Although the client is at term with a fetal demise, emergent cesarean is not indicated. The priority is maternal safety, and vaginal delivery is preferred unless there is uncontrolled maternal hemorrhage or other complications. Cesarean would increase maternal surgical risk without benefiting the fetus.