The emergency department nurse notes that a patient with chronic kidney failure has a potassium level of 6.5 mEq/L. Which medications would the nurse expect to administer? Select all that apply.

correct answer/s is A and D.

Choice A rationale:

Prostaglandins:

Mechanism of action: Prostaglandins are hormone-like substances that play a crucial role in labor initiation. They act by softening and ripening the cervix, stimulating uterine contractions, and rupturing the amniotic sac.

Types: Prostaglandins used for labor induction include:

Dinoprostone (Cervidil, Prepidil): Inserted into the vagina as a gel or pessary.

Misoprostol (Cytotec): Administered orally or vaginally.

Effectiveness: Generally effective in initiating labor within 24 hours, with success rates ranging from 60-85%.

Advantages:

Can be used when the cervix is unfavorable (not ripe).

Can be administered in a variety of ways to suit the patient's preferences.

May have a lower risk of uterine hyperstimulation compared to oxytocin.

Disadvantages:

Can cause side effects such as nausea, vomiting, diarrhea, and fever.

May increase the risk of uterine rupture, especially in women with a history of cesarean delivery.

Choice D rationale:

Amnioinfusion:

Procedure: Involves the infusion of sterile saline solution into the amniotic sac through a small catheter.

Mechanism of action: Not fully understood, but it's thought to work by:

Increasing amniotic fluid volume, which can help to stimulate contractions.

Stretching the uterine walls, which may trigger the release of prostaglandins.

Reducing pressure on the umbilical cord, which can improve fetal oxygenation.

Effectiveness: Usually used in conjunction with other induction methods, such as oxytocin or prostaglandins. Has a success rate of about 50-60% in initiating labor within 24 hours.

Advantages:

May be helpful in cases of low amniotic fluid (oligohydramnios).

Can decrease the risk of umbilical cord compression.

Disadvantages:

Requires the insertion of a catheter into the uterus, which carries a small risk of infection.

May cause discomfort for the mother.

Choice C rationale:

It is a misconception that fetal movement decreases as delivery approaches. While the nature of the movements may change— becoming less like kicks and more like rolls or twists due to less space in the uterus—the frequency of movements should remain consistent. In fact, increased fetal movement can be a sign of labor approaching. Therefore, a pregnant client who believes that fetal movements will decrease closer to delivery needs further instruction to ensure they are aware of this important health indicator.

Here's a detailed explanation of why the other choices are correct:

Choice A: This statement is correct. Fetal kick counts can be performed at home, providing a convenient and comfortable way to monitor fetal well-being.

Choice B: This statement is also correct. A decrease in fetal movement, defined as less than 3 kicks in an hour, is a potential concern and warrants contacting a healthcare provider for further evaluation.

Choice D: This statement is accurate as well. Daily fetal kick counts are generally recommended to establish a baseline of the baby's usual activity pattern and to detect any significant changes that might indicate a problem.