A provider orders intravenous pain medication for a pregnant client who is now requesting pain medication due to kidney stones.

Order: Hydromorphone 1.5 mg IV push every 4 hours as needed for pain.

The only available concentration in the pyxis is 4 mg per 1 ml. How many milliliters should the nurse administer? Round to the tenths place.

Enter numeric value only.

Choice A rationale

Intrauterine growth restriction (IUGR) is a condition where the fetus is smaller than normal, and it is more commonly associated with oligohydramnios, which is an insufficient amount of amniotic fluid. This occurs because the fetus may not be producing enough urine, which is the primary contributor to amniotic fluid after the first trimester.

Choice B rationale

Maternal diabetes mellitus is a common cause of polyhydramnios. Poorly controlled maternal hyperglycemia can lead to fetal hyperglycemia. This, in turn, causes fetal polyuria, or excessive urination, which significantly increases the volume of amniotic fluid. This is due to the osmotic effect of elevated glucose levels in the fetal circulation.

Choice C rationale

Dehydration in the mother is more likely to cause oligohydramnios, not polyhydramnios. When the mother is dehydrated, her blood volume and subsequent placental blood flow may be reduced, which can affect the production of amniotic fluid. This is in contrast to polyhydramnios, which is an excess of amniotic fluid.

Choice D rationale

Chronic hypertension is more typically associated with conditions that can lead to placental insufficiency and oligohydramnios. Poor placental perfusion resulting from hypertension can compromise fetal growth and reduce fetal urinary output, thereby leading to decreased amniotic fluid volume, which is the opposite of polyhydramnios

Choice C rationale

An increase in vaginal discharge or leaking of fluid is an important symptom to report. A sudden increase in watery discharge or a gush of fluid could indicate premature rupture of membranes (PROM), which places both the mother and fetus at risk for infection and premature birth. Reporting this allows for prompt evaluation and appropriate medical intervention to prevent complications.

Choice A rationale

A weight gain of one pound per week during the second and third trimesters is within the normal range. The recommended weight gain is typically 0.5 to 1 pound per week for a woman with a normal BMI. A sudden, rapid weight gain (more than 2 pounds in a week) could be a sign of preeclampsia, which is what the client should be instructed to report.

Choice B rationale

While urinary frequency is normal during pregnancy, especially in the first and third trimesters due to hormonal changes and uterine pressure on the bladder, the client should be instructed to report burning. Burning upon urination is a key symptom of a urinary tract infection (UTI), which is common in pregnancy and can lead to more serious complications like pyelonephritis if left untreated.

Choice D rationale

Severe nausea and vomiting (hyperemesis gravidarum) can lead to dehydration and electrolyte imbalances. Waiting for it to last more than seven days before reporting it is inappropriate. The client should be instructed to report severe nausea and vomiting if it prevents her from keeping fluids down, as this can lead to dehydration and malnutrition, requiring immediate medical attention and potential hospitalization.