Take full exam for free

A nurse is assisting with the care of a 30-year-old female client who is scheduled to receive a dose of dinoprostone in the maternal newborn unit.

 

Exhibit 1: Vital Signs

 

  • Heart rate: 88/min
  • Temperature: 37.1°C (98.8°F)
  • Respiratory rate: 16/min
  • Blood pressure: 122/78 mm Hg

 

Exhibit 2: Provider Prescriptions

 

  • Levothyroxine 100 mcg PO once daily in PM
  • Acetaminophen 325 mg PO every 6 hr PRN
  • Dinoprostone 10 mg intravaginally x one dose now
  • Terbutaline 2.5 mcg/min intravenous per provider's instructions

 

Exhibit 3: Laboratory Results

 

  • WBC count: 9,500/mm³ (Normal: 5,000 to 15,000/mm³)
  • Hgb: 10.5 mg/dL (Normal: greater than 11 mg/dL)
  • Hct: 31% (Normal: greater than 33%)
  • Platelets: 225,000/mm³ (Normal: 150,000 to 400,000/mm³)
  • Blood Type/Rh: O+

 

Exhibit 4: Assessment

 

The fetal heart rate is 140/min with moderate variability, and mild uterine irritability is noted. The abdomen is soft and nontender upon palpation. Cervical examination reveals dilation of 1 cm, thickness, and no presenting part palpable. An ultrasound shows a footling breech presentation. There are clusters of lesions noted on the vaginal introitus and labia majora.

 

Exhibit 5: History and Physical

 

The client is gravida 2 para 1, with a previous vaginal delivery. She has a history of hypothyroidism and Herpes simplex virus type 2. She is currently undergoing labor induction at 39 weeks and 3 days of gestation.

 

Querry

For which of the following findings should the nurse anticipate a provider's prescription to withhold the dinoprostone? Select all that apply.

A.

Breech presentation

B.

Terbutaline administration

C.

FHR (Fetal Heart Rate)

D.

WBC count

E.

Lesions noted

Question Solution

Correct Answer : A,C,E

Choice A rationale:

 

Breech presentation is a contraindication for dinoprostone as it increases the risk of complications during labor and delivery. Using dinoprostone to induce labor in a non-vertex presentation can lead to issues such as cord prolapse or obstructed labor, which necessitate a cesarean section for safe delivery.

 

Choice B rationale:

 

Terbutaline administration is used to manage preterm labor by relaxing the uterus. While it is relevant in labor management, it does not directly contraindicate the use of dinoprostone. Terbutaline and dinoprostone can be used in conjunction if properly managed.

 

Choice C rationale:

 

Fetal heart rate (FHR) monitoring showing abnormalities is a potential reason to withhold dinoprostone. Dinoprostone can increase uterine contractions, potentially stressing the fetus. A stable FHR with moderate variability indicates fetal well-being; however, if there were concerns, the provider might withhold dinoprostone.

 

Choice D rationale:

 

A WBC count of 9,500/mm³ is within the normal range and does not indicate an infection or condition that would contraindicate dinoprostone use. Elevated WBC count could raise concerns, but in this case, it is normal and not a contraindication.

 

Choice E rationale:

 

Lesions noted on the vaginal introitus and labia majora, likely caused by Herpes simplex virus, are a contraindication for dinoprostone. Active genital herpes lesions increase the risk of neonatal herpes transmission, making vaginal delivery risky. In such cases, cesarean delivery is often preferred to prevent transmission.


View Related questions

Correct Answer is C

Explanation

Choice A rationale

Taking an over-the-counter antacid is not recommended for managing nausea during pregnancy without consulting a healthcare provider. Some antacids contain ingredients that may not be safe during pregnancy.

Choice B rationale

Increasing intake of fresh fruits might help with hydration and nutrition but is not specifically effective in managing morning nausea. Some fruits might even exacerbate nausea due to their acidity.

Choice C rationale

Eating dry, bland foods in the morning can help manage nausea for pregnant clients. Foods like crackers, toast, and cereals are easy on the stomach and can help reduce morning sickness.

Choice D rationale

Restricting fluids to 1,000 mL/day is not advisable. Proper hydration is crucial during pregnancy, and such restriction can lead to dehydration and other complications. Fluids should be encouraged rather than restricted.

Correct Answer is B

Explanation

Choice A rationale

Bleeding gums can be common during pregnancy due to increased blood flow and hormonal changes that affect the gums, causing them to be more sensitive and prone to bleeding. It's usually not a cause for immediate concern unless it's severe or accompanied by other symptoms.

Choice B rationale

Abdominal cramping at 26 weeks of gestation could indicate preterm labor or other complications, such as placental abruption. It's a significant symptom that needs immediate medical attention to ensure both maternal and fetal well-being.

Choice C rationale

White vaginal discharge, known as leukorrhea, is common during pregnancy due to increased production of estrogen and greater blood flow to the vaginal area. It helps prevent infections and usually does not indicate a problem unless it has a foul odor or is accompanied by itching or irritation.

Choice D rationale

Asymptomatic palpitations are relatively common during pregnancy due to increased blood volume and changes in circulation. They usually don't indicate a serious problem unless they're severe, persistent, or accompanied by other symptoms like chest pain or shortness of breath.