Which complication would the nurse consider for a client with a fetus in a breech presentation?

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.

Step 1 is: Convert the ordered rate from mU/min to mU/hr. 20 mU/min× 60 min/hr = 1200 mU/hr.

Step 2 is: Convert the available concentration from units/mL to mU/mL. 20 units = 20,000 mU (since 1 unit = 1000 mU). The concentration is 20,000 mU÷ 1000 mL = 20 mU/mL.

Step 3 is: Calculate the infusion rate in mL/hr. 1200 mU/hr÷ (20 mU/mL). 60 mL/hr. The oxytocin will infuse at 60 mL/hr.