The nurse is administering methylergonovine 0.2 mg to a healthy postpartum client with uterine atony.
Which assessment will the nurse need to make prior to administering the medication?
If blood pressure is lower than 140/90 mm Hg.
If hematocrit level is higher than 45%.
If urine output is higher than 50 ml/hr.
The Correct Answer is A
Choice A rationale
Methylergonovine is a vasoconstrictor that stimulates smooth muscle contraction in the uterus to control postpartum hemorrhage. However, this vasoconstrictive effect is not limited to the uterus and can cause a systemic increase in blood pressure. The medication is contraindicated in patients with hypertension, with a systolic blood pressure greater than 140 mm Hg or a diastolic blood pressure greater than 90 mm Hg, to prevent a hypertensive crisis or cerebrovascular accident.
Choice B rationale
Hematocrit is the percentage of red blood cells in the blood and is used to assess for anemia or polycythemia. A normal hematocrit range for women is 37-47%. While anemia is a common concern postpartum, and a low hematocrit may indicate significant blood loss, it is not a primary contraindication for methylergonovine administration. The drug's primary side effect is related to blood pressure, not hematological status.
Choice C rationale
Urine output is an indicator of renal perfusion and overall hydration status. A normal urine output is typically greater than 30 ml/hr. While decreased urine output could indicate hypovolemia or renal dysfunction, it is not a direct contraindication for methylergonovine. The medication's effect on blood pressure is the primary safety consideration, not its effect on renal function or urine output.
Choice D rationale
Dizziness or lightheadedness can be a sign of orthostatic hypotension or blood loss. Assessing for dizziness is an important part of a postpartum assessment, but it is not a specific contraindication for methylergonovine. The medication's primary risk is hypertension, which is not directly related to a client's baseline experience of dizziness. A baseline blood pressure measurement is a more specific and crucial assessment.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Insomnia is a common symptom of postpartum depression, often characterized by difficulty falling or staying asleep, or waking up early. This sleep disturbance, when coupled with other symptoms such as persistent sadness, loss of interest in activities, and fatigue, is a key diagnostic criterion for the condition.
Choice B rationale
Intermittent crying in the first week postpartum, now resolved, is a common symptom of the "baby blues.”. The baby blues are a transient condition, typically resolving within the first two weeks. Postpartum depression, in contrast, involves more severe and persistent symptoms lasting longer than two weeks.
Choice C rationale
Delusions are a symptom of postpartum psychosis, a rare and severe mental health condition that is distinct from postpartum depression. Postpartum psychosis involves a break from reality and is a psychiatric emergency. Delusions are not characteristic of postpartum depression.
Choice D rationale
Induced vomiting is a symptom associated with eating disorders, such as bulimia nervosa. While eating disorders can coexist with postpartum depression, induced vomiting is not a defining symptom of postpartum depression itself. It is a separate clinical finding.
Correct Answer is C
Explanation
Choice A rationale
Preparing for a vaginal delivery is not the immediate first action. The fetal heart rate pattern indicates potential fetal distress, which needs to be addressed and corrected before any definitive decisions about the mode of delivery are made. The priority is to improve uteroplacental blood flow and fetal oxygenation.
Choice B rationale
Administering oxygen at 8 to 10 liters via nasal cannula may be a secondary intervention if turning the client is not effective. The primary cause of late decelerations is uteroplacental insufficiency. While oxygen can help, the initial and most effective intervention is to reposition the mother to improve blood flow.
Choice C rationale
Late decelerations, which are characterized by a gradual decrease in fetal heart rate after the peak of a contraction and a gradual return to baseline after the contraction has ended, are most often caused by uteroplacental insufficiency. Turning the client on their side, particularly the left side, relieves pressure on the vena cava, improving venous return to the heart, which in turn increases uteroplacental blood flow and fetal oxygenation.
Choice D rationale
Performing a vaginal exam to assess for the umbilical cord is the appropriate intervention for variable decelerations, not late decelerations. Variable decelerations are caused by umbilical cord compression. A vaginal exam would not address the underlying issue of uteroplacental insufficiency responsible for late decelerations.
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