A nurse is teaching a client about iron supplementation during pregnancy.
Which of the following client statements indicates an understanding of the teaching?

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

The American Academy of Pediatrics recommends that infants remain in a rear-facing car seat until they reach the maximum height or weight allowed by the car seat manufacturer, which often corresponds to approximately 2 years of age or older. This position provides superior protection for the infant's head, neck, and spine in the event of a frontal collision by distributing crash forces more effectively.

Choice B rationale

A five-point harness, not a four-point harness, is the standard and safest restraint system for infant and child car seats. The five points of attachment (shoulders, hips, and crotch) distribute crash forces across the strongest parts of the body, providing maximum protection and preventing ejection from the seat.

Choice C rationale

For a rear-facing car seat, the shoulder harness straps should be positioned at or *below* the baby's shoulders. This ensures that the straps are snug and correctly restrain the child, preventing upward movement and potential ejection during a collision. Placing them above the shoulders would not provide optimal restraint.

Choice D rationale

An infant car seat should be positioned at a 45-degree angle, not a 30-degree angle. This reclined position is crucial for maintaining an open airway for the infant, especially newborns who lack full head and neck control, and for preventing their head from falling forward, which could obstruct breathing.