The nurse is preparing the client for discharge.

Exhibits

Which of the following statements indicate the client understands the discharge teaching?

Select the 3 client statements that indicate an understanding of the teaching.

A. Bradycardia is not a common adverse effect of levodopa-carbidopa. Instead, it may sometimes cause tachycardia (increased heart rate) in some patients. Monitoring for cardiovascular changes is essential, but bradycardia is not typically associated with this medication.
B. Hypotension is a documented adverse effect of levodopa-carbidopa. This medication can cause orthostatic hypotension, which is a drop in blood pressure when standing up, leading to dizziness or fainting. This finding should be carefully monitored and documented, as it can increase the risk of falls.
C. Constricted pupils are not typically an adverse effect of levodopa-carbidopa. Instead, this medication may cause dilated pupils (mydriasis) as a result of its effects on the autonomic nervous system, particularly if the patient is taking other medications that can affect pupil size.
D. Urinary frequency can occur with levodopa-carbidopa; however, it is not commonly classified as a significant adverse effect. While changes in urinary habits can happen, they are more often related to Parkinson's disease itself rather than the medication specifically. Therefore, urinary frequency should be monitored but is not a primary concern compared to hypotension.

Rationale for Correct Options:

1. Late decelerations on fetal heart rate (FHR) – First Priority

Late decelerations are a sign of uteroplacental insufficiency, meaning the fetus is not receiving adequate oxygen. This is the most urgent concern because prolonged fetal distress can lead to hypoxia and acidosis, increasing the risk of complications such as stillbirth or emergency cesarean birth. Nursing Actions: Reposition the client to left lateral position to improve placental perfusion. Administer oxygen at 10 L/min via a non-rebreather mask. Increase IV fluids to improve maternal circulation. Stop oxytocin if it's being used, as it may be causing excessive contractions. Notify the provider immediately for further interventions, such as potential intrauterine resuscitation or emergent delivery.

1. Positive Group B streptococcus (GBS) status – Second Priority

The client tested positive for GBS, a bacterial infection that can be transmitted to the newborn during birth, leading to neonatal sepsis, pneumonia, or meningitis. While this is a significant concern, it is secondary to the immediate fetal distress from late decelerations. Nursing Actions: Administer IV antibiotics (penicillin G or an alternative) as ordered to prevent neonatal infection. Monitor for signs of infection in the newborn after delivery.

Rationale for Incorrect Options:

• Severe back pain rated 10/10 – Pain management is important, but fetal distress takes precedence over maternal discomfort.
• Restlessness and irritability – These could indicate maternal distress or labor progression, but they are not as urgent as fetal oxygenation.
• Increasing contraction intensity and frequency – This is expected as labor progresses but is not immediately life-threatening.
• Fatigue and emotional distress – While support is essential, it is not a priority over fetal well-being or preventing neonatal infection.