The practical nurse (PN) is caring for an infant admitted with vomiting, diarrhea, and dehydration.

The PN weighs the diapers to calculate urinary output.

How many mL of urine output should the PN record for a wet diaper weight of 75 grams compared to the dry diaper weight of 50 grams?

Choice A rationale

Methylergonovine is an ergot alkaloid that directly stimulates sustained uterine contractions. This action is crucial in controlling postpartum hemorrhage by compressing blood vessels within the myometrium, thereby reducing blood loss. The observed excessive bleeding with this delivery necessitates intervention to prevent complications like hypovolemic shock. Its pharmacological effect targets smooth muscle receptors in the uterus.

Choice B rationale

Routine prescription based solely on parity (number of previous pregnancies) is not standard medical practice. Methylergonovine is administered based on clinical indication, primarily to prevent or manage postpartum hemorrhage, which is determined by factors like uterine atony or excessive bleeding, not simply the number of previous births. Unnecessary administration can lead to adverse effects.

Choice C rationale

While methylergonovine does contract the uterus and prevent excess bleeding, this response is a general statement. The best response directly addresses the client's current situation and her question about why *she* is receiving it *this time*. It is crucial to explain the specific clinical reason for her individual prescription, which in this context is likely due to the increased bleeding.

Choice D rationale

This response shifts the responsibility back to the client and does not provide the requested information. It fails to address the client's direct question about the medication's purpose in her specific situation. Providing clear and concise information is essential for client education and adherence to the treatment plan.

Choice A rationale

While nausea can occur from analgesics used during labor, and solid foods might exacerbate it, this is not the primary or most critical reason for withholding them. The major concern is related to potential aspiration during anesthesia or an emergency. Analgesics can also cause gastric stasis, but the aspiration risk remains paramount.

Choice B rationale

If general anesthesia becomes necessary during labor, the risk of pulmonary aspiration of gastric contents is significantly increased due to delayed gastric emptying and relaxation of the gastroesophageal sphincter. Aspiration pneumonitis can lead to severe respiratory complications. Therefore, withholding solid foods minimizes this critical risk.

Choice C rationale

Gastric emptying time actually increases during labor, meaning food remains in the stomach for a longer duration. This prolonged retention of gastric contents heightens the risk of aspiration if the client requires general anesthesia or experiences emesis. Reduced peristalsis contributes to this extended emptying time.

Choice D rationale

Autonomic nervous system stimulation, specifically sympathetic activation, during labor leads to a decrease in gastrointestinal motility and peristalsis. This physiological response contributes to delayed gastric emptying, increasing the volume of gastric contents and subsequently elevating the risk of aspiration.