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.
Breech presentation
Terbutaline administration
FHR (Fetal Heart Rate)
WBC count
Lesions noted
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.
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View Related questions
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.
Correct Answer is A
Explanation
Choice A rationale
Respiratory rate of 10/min is a critical adverse effect, indicating potential respiratory depression due to magnesium sulfate, a serious and life-threatening condition requiring immediate intervention.
Choice B rationale
Urine output of 160 mL in 4 hours is lower than expected but not immediately life-threatening. It needs monitoring but is not as critical as respiratory rate.
Choice C rationale
Diaphoresis, or excessive sweating, can be a side effect of magnesium sulfate but is not life-threatening. It warrants attention but does not require immediate reporting.
Choice D rationale
Nausea is a common, less severe side effect of magnesium sulfate that does not indicate an urgent situation.