Methylergonovine is prescribed for a client to treat postpartum hemorrhage caused by uterine atony.
Prior to the nurse administering the medication, what assessment is the priority?
Amount of blood loss.
The blood pressure.
The level of consciousness.
The uterine tone.
The Correct Answer is B
Choice A rationale
While the amount of blood loss is critical for determining the severity of the hemorrhage and the need for immediate treatment, it is not the priority assessment before administering methylergonovine. The amount of blood loss determines the need for the drug, but the blood pressure determines its safety before administration. Methylergonovine is a potent vasoconstrictor and must be used cautiously in clients with elevated blood pressure to prevent hypertensive crisis or stroke.
Choice B rationale
Methylergonovine is an ergot alkaloid that acts as a potent vasoconstrictor and uterine stimulant. Its primary side effect and contraindication are hypertension and preeclampsia. Because the drug dramatically increases systemic vascular resistance, it can cause a sudden, severe elevation in blood pressure. Therefore, checking the blood pressure is the priority assessment to ensure the client's pressure is within safe limits before administration, preventing potential complications like stroke.
Choice C rationale
Although a change in the level of consciousness (LOC) could indicate hypovolemic shock from severe blood loss or a hypertensive emergency, it is a secondary finding. The primary, direct, and modifiable risk associated with methylergonovine administration is its potential to cause acute, severe hypertension. Checking the client's baseline blood pressure (Choice B) is the specific, essential safety check before administering this vasoconstrictive medication.
Choice D rationale
The uterine tone or atony is the indication for the medication; the client is already diagnosed with uterine atony (flaccid uterus) causing the hemorrhage. The medication's purpose is to contract the uterus (increase tone). The priority before administration, however, is to assess the client for contraindications or serious adverse reaction risks. The potent vasoconstrictive effect on peripheral arteries makes blood pressure (Choice B) the most critical pre-administration safety assessment.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Appropriate for gestational age (AGA) refers to neonates whose weight falls between the 10th and 90th percentiles for their gestational age. The neonate is term (38 weeks), but weighs 4,017 grams, which is >4,000 grams and classified as macrosomic, thus >90th percentile and not AGA. The classification of AGA is based on a statistical growth curve and is distinct from being macrosomic.
Choice B rationale
Large for gestational age (LGA) describes neonates whose weight is above the 90th percentile for their gestational age, which includes those with macrosomia (birth weight >4,000 g). This neonate weighs 4,017 g, placing them in the LGA category. Term is defined as a birth occurring between 37 weeks 0 days and 41 weeks 6 days gestation, making 38 weeks a term birth.
Choice C rationale
Large for gestational age (LGA) is correct for this 4,017 g neonate, as their weight exceeds the 90th percentile for 38 weeks' gestation. However, preterm refers to births occurring before 37 weeks 0 days gestation. Since this neonate was born at 38 weeks' gestation, the "preterm" classification is incorrect because 38 weeks is within the term range.
Choice D rationale
Appropriate for gestational age (AGA) is incorrect because this neonate's weight of 4,017 g is greater than the 90th percentile for a 38-week gestation, classifying them as large for gestational age (LGA). Term is correct as the neonate was born at 38 weeks' gestation, which is within the 37 weeks 0 days to 41 weeks 6 days range, making the overall classification inaccurate.
Correct Answer is D
Explanation
Choice A rationale
Placental abruption is the premature detachment of the normally implanted placenta from the uterine wall. The client's placenta is low-implanted, suggesting a placenta previa risk, not abruption. While the small for gestational age (SGA) fetus is associated with placental insufficiency, abruption is typically characterized by acute vaginal bleeding and pain, not exclusively by a low-implanted placenta on ultrasound.
Choice B rationale
Placenta accreta is an abnormal adherence of the placenta to the uterine wall, invading the myometrium. It is a major risk in clients with a history of previous cesarean births or uterine surgery. A low-implanted placenta (previa) on its own, without a history of uterine scarring, is not the primary indicator for accreta planning, which is focused on hemorrhage risk at delivery.
Choice C rationale
Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation. While a small for gestational age (SGA) fetus and placental issues can increase the risk of preterm labor, the specific finding of a low-implanted placenta on a 28-week ultrasound points more directly to the risk of placenta previa, which is the priority teaching topic.
Choice D rationale
Placenta previa is the implantation of the placenta over or near the internal cervical os. A low-implanted placenta revealed at 28 weeks' gestation is a strong indicator of an increased risk for previa as the pregnancy progresses. The associated fetal growth restriction (SGA) is often related to the placenta's suboptimal location and functionality, requiring teaching on bleeding precautions and warning signs.
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