1.A nurse receives orders from a health care provider for an elective induction of labor. The provider orders dinoprostone (Cervidil) for cervical ripening. For which client should the nurse question this order? Client A, who is G1P0 and 41 weeks gestation. Client C, who is G2P1 at 39 weeks gestation and had a c-section for breech. Client D, who is G1P0 at 39 weeks, a gestational diabetic, with evidence of fetal macrosomia Client B, who is G5P4 at 40 weeks gestation. 2.A nurse is preparing to give Terbutaline Sulfate to a pregnant woman. The nurse knows she needs to complete which assessment to giving the medication: Respirations Maternal heart rate Fetal heart rate Blood pressure 3.A nurse is teaching a patient on Procardia (Nifedipine) XL for management of her preterm labor. What is teaching when discussing the side effects of the medication? Take the medication at the same time every day. You only need to take the medication when you feel like you are having contractions. Take this medication with food. Be sure to change positions slowly. 4.A client, who is G1P1 is experiencing a great deal of bleeding after a vaginal delivery. She had a long, three-day induction for preeclampsia with elevated blood pressure. She received 24 hours of therapy for cervical ripening and 48 hours of Pitocin (oxytocin) therapy. The nurse anticipates that the provider will order: Oxytocin (Pitocin) 10 units IM Methylergonovine (Methergine) 0.2 mg IM Magnesium Sulfate 2 gm per hour Carboprost (Hemabate) 250 mcg IM.

1. The nurse should question the order of dinoprostone (Cervidil) for cervical ripening in Client A, who is G1P0 and 41 weeks gestation. This is because the client is a primigravida (G1P0) and is already at term (41 weeks gestation), which means that her cervix is likely to be ripe. Cervical ripening medications are typically used when the cervix is not favorable or not yet ripe for labor. In this case, it would be more appropriate to consider other methods of induction or to allow for spontaneous labor to occur.

2. Before administering Terbutaline Sulfate to a pregnant woman, the nurse should complete an assessment of the fetal heart rate. This is because Terbutaline Sulfate is a medication that is used to relax the smooth muscles of the uterus and can potentially affect the fetal heart rate. It is important to ensure that the fetal heart rate is within normal range before administering the medication. Assessing the maternal heart rate, blood pressure, and respiratory rate are also important assessments to complete, but the assessment of the fetal heart rate is specifically related to the medication administration.

3. When teaching a patient on Procardia (Nifedipine) XL for the management of preterm labor, it is important to discuss the side effects of the medication. One important teaching point is to take the medication at the same time every day. This is important for maintaining consistent blood levels of the medication and optimal therapeutic effect. Taking the medication only when contractions are felt would not be appropriate, as the medication should be taken as prescribed and not based on symptomatology. Taking the medication with food can help minimize gastrointestinal side effects, but it is not the most important teaching point. Changing positions slowly is a relevant teaching point for patients on medications that can cause orthostatic hypotension, but it is not specific to Procardia (Nifedipine) XL.

4. In a client who is G1P1 and experiencing a great deal of bleeding after a vaginal delivery, with a history of preeclampsia and a long induction process, the nurse can anticipate that the provider will order Oxytocin (Pitocin) 10 units intramuscularly (IM). This medication is commonly used after delivery to help contract the uterus and control postpartum bleeding. Methylergonovine (Methergine) 0.2 mg IM is another medication that is used to control postpartum bleeding, but it is contraindicated in patients with a history of preeclampsia due to the potential risk of increased blood pressure. Magnesium Sulfate 2 gm per hour is a medication used for preeclampsia, but it is not indicated for controlling postpartum bleeding. Carboprost (Hemabate) 250 mcg IM is also used for postpartum hemorrhage, but it is not the initial medication of choice and would typically be used if the bleeding persists after initial interventions.

In summary, the nurse should question the order of dinoprostone (Cervidil) for cervical ripening in a term primigravida. Before administering Terbutaline Sulfate to a pregnant woman, the nurse should complete an assessment of the fetal heart rate. When teaching a patient on Procardia (Nifedipine) XL for preterm labor, it is important to discuss taking the medication at the same time every day. In a client experiencing postpartum bleeding after a long induction for preeclampsia, it is anticipated that the provider will order Oxytocin (Pitocin) 10 units IM.