A nurse is developing a plan of care for a client who is in the latent phase of labor.
Which of the following interventions should the nurse include in the plan to manage the client's pain?

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

A single dose of the rubella vaccine is typically sufficient to confer immunity. A second dose is not routinely recommended after postpartum administration. The primary goal is to prevent congenital rubella syndrome in future pregnancies by ensuring the mother develops adequate antibody titers to the virus.

Choice B rationale

The rubella vaccine contains live attenuated virus, which carries a theoretical risk of congenital rubella syndrome if the vaccine virus crosses the placenta during pregnancy. Therefore, clients are advised to avoid conception for at least 1 to 3 months, commonly stated as 4 months, after vaccination to minimize any potential fetal exposure.

Choice C rationale

The rubella immunization typically provides long-lasting immunity. It is not necessary to receive an additional rubella immunization during the first trimester of a subsequent pregnancy. Antibody titers are usually maintained, protecting against future rubella infection and subsequent fetal harm.

Choice D rationale

The rubella vaccine is considered safe for breastfeeding mothers and their infants. The live attenuated virus is not shed in breast milk in significant amounts that would pose a risk of infection to the infant. Therefore, breastfeeding can continue without interruption after rubella immunization.