The nurse anticipates the health care provider will order methylergonovine for which purpose?

intranasally
Explanation:
The nurse should administer oxytocin intranasally to a client to stimulate the milk ejection reflex. Oxytocin can be given intramuscularly (IM) during the third stage of labor (period from the time the baby is born until the placenta is expelled) to produce uterine contractions and control postpartum bleeding and lessen hemorrhage potential. The other uterine stimulants may be given orally, rectally, or IM during the postpartum period to reduce the possibility of postpartum hemorrhage and to prevent relaxation of the uterus. Oxytocin is not given topically.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543.

Chapter 46: Uterine Drugs - Page 543

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cardiac arrhythmias
Explanation:
A nurse should monitor a client receiving oxytocin for the following adverse effects: fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Hypotension, headache, and dizziness are not adverse reactions of oxytocin. Hypotension can be seen with uterine rupture due to hypovolemia, along with dizziness due to low blood pressure. Headache can be seen with the use of hormone medications such as birth control.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548.

Chapter 46: Uterine Drugs - Page 548

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opioids
sedatives
analgesics
Explanation:
There is an increased effectiveness of CNS depressants such as opioids, analgesics, and sedatives when coadministered with magnesium sulfate. The effectiveness of neuromuscular blocking agents is enhanced as well. However, the addition of magnesium sulfate leads to the lowering of blood levels of tetracycline. Magnesium sulfate interferes with the absorption of digoxin, potentially reducing its efficacy.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546.

Chapter 46: Uterine Drugs - Page 546

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drowsiness
confusion
rapid breathing
Explanation:
When oxytocin is administered IV, there is a danger of an excessive fluid volume (water intoxication) because oxytocin has an antidiuretic effect. The nurse should measure the fluid intake and output and look for signs of fluid overload such as drowsiness, confusion, headache, listlessness, wheezing, coughing, and rapid breathing and inform the primary health care provider if any of these are noted. As the fluid output is decreased in this condition, the client will not show signs of increased micturition. Pain is normally involved with any kind of parenteral therapy and is not a characteristic sign to distinguish water intoxication.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544.

Chapter 46: Uterine Drugs - Page 544

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Assess for contraindications or cautions.
Explanation:
Abortifacients should not be used with any known allergy to abortifacients or prostaglandins to avoid hypersensitivity reactions, after 20 weeks from the last menstrual period which would be too late into the pregnancy for an abortion, or with active PID or acute cardiovascular, hepatic, renal, or pulmonary disease. Assessing vital signs would be important and so would drawing up the medication and injecting within 5 minutes, but they are not the most important nursing actions. It would be inappropriate to try to talk the mother out of taking the drug.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544.

Chapter 46: Uterine Drugs - Page 544

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Place the client in a lateral position and monitor closely
Explanation:
In the event of tachysystole with a reassuring FHR, the nurse should: (1) place the mother in a lateral position, (2) provide an IV fluid bolus of 500 mL lactated Ringers, (3) if uterine activity has not returned to normal after 10 minutes, decrease oxytocin rate by half, and (4) if uterine activity has not returned to normal after 10 minutes more, discontinue oxytocin until normal uterine activity resumes and notify the provider.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 547.

Chapter 46: Uterine Drugs - Page 547

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A 25-year-old with diabetes mellitus
Explanation:
Oxytocin is contraindicated in cephalopelvic disproportion (fetal head relative to maternal pelvis) and with unfavorable fetal positions or presentations that must be converted before delivery (such as transverse lie). Contraindications for vaginal delivery include invasive cervical carcinoma, active genital herpes, cord presentation or prolapse, total placenta previa, and vas previa.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546.

Chapter 46: Uterine Drugs - Page 546

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Terbutaline
Explanation:
The use of terbutaline for more than 48 hours or in the home setting is not advised. Because the client is 30 weeks, tocolytic therapy will need to be continued for up to seven weeks. Magnesium, indomethacin, and nifedipine could also be used for more than 48 hours.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546.

Chapter 46: Uterine Drugs - Page 546

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Fetal heart rate
Client blood pressure
Client respiratory rate
Explanation:
Immediately prior to beginning the IV infusion of oxytocin, the nurse assesses and documents the fetal heart rate and the client's blood pressure, pulse, and respiratory rate. It is not necessary to assess the client's pain rating or the amount of fetal movement prior to starting the infusion.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544.

Chapter 46: Uterine Drugs - Page 544

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The uterine contractions are occuring every 90 seconds.
Explanation:
The health care provider should be notified immediately if there is a marked change in the frequency, rate, or rhythm of uterine contractions; uterine contractions that last more than 60 seconds; and contractions occurring more frequently than every 2-3 minutes. The client's blood pressure and pulse are within normal limits and the fetal heart rate is within normal limits.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544.

Chapter 46: Uterine Drugs - Page 544

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Cold, bluish colored feet
Explanation:
Women who are heavy smokers are at risk for excessive vasoconstriction when receiving oxytocin. A sign of vasoconstriction would be lack of blood flow to the feet, resulting in cold feet that are blue in color. Swollen hands, diarrhea, and hypotension are not signs of vasoconstriction.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 547.

Chapter 46: Uterine Drugs - Page 547

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Fetal heart rate of 84 bpm
Explanation:
Though oxytocin does not cause many fetal problems, fetal bradycardia can occur, which is one of the reasons that electronic fetal monitoring is required if a woman receives oxytocin. Oxytocin has not been known to cause fetal tachycardia, or problems with fetal movement.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544.

Chapter 46: Uterine Drugs - Page 544

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Hypocalcemia
Explanation:
The adverse reactions associated with IV magnesium therapy are related to hypocalcemia, not hypokalemia, hypernatremia, or hyperphosphatemia.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546.

Chapter 46: Uterine Drugs - Page 546

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Chest pain
Explanation:
The use of ergonovine and methylergonovine can result in ergotism, which is characterized by coolness, numbness and tingling of extremities, dyspnea, nausea, confusion, tachycardia or bradycardia, chest pain, hallucinations, and convulsions.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543.

Chapter 46: Uterine Drugs - Page 543

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Antidiuretic effects
Vasopressor effects
Explanation:
Oxytocin is a hormone with uterus-stimulating properties that act on the smooth muscle, especially in pregnancy. As pregnancy progresses, the sensitivity of the uterus to oxytocin increases. Oxytocin also has antidiuretic and vasopressor effects. Oxytocin is more likely to cause hypertension, not decreased blood pressure and a rise in blood sugar levels due to the body's natural stress response.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543.

Chapter 46: Uterine Drugs - Page 543

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Fetal bradycardia
Uterine rupture
Cardiac arrhythmias
Uterine hypertonicity
Explanation:
The administration of oxytocin may result in the following adverse reactions: feta bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardia arrhythmias, and anaphylactic reactions.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543.

Chapter 46: Uterine Drugs - Page 543

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Significant change in FHR or rhythm
Marked change in frequency, rate, or rhythm of contractions
Contractions lasting longer than 60 seconds
Marked increase in client's blood pressure
Contractions more frequent than every 2 to 3 minutes
Explanation:
When monitoring uterine contractions, whether the client is on IV oxytocin or not, the nurse notifies the provider immediately if any of the following occurs: significant change in fetal heart rate or rhythm; a marked change in the frequency, rate, or rhythm of contractions; contractions that last longer than 60 seconds or occur more frequently than every 2 to 3 minutes; no palpable relaxation of the uterus; a marked increase or decrease in the client's blood pressure or pulse; or any change in the client's general condition.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544.

Chapter 46: Uterine Drugs - Page 544

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drowsiness
confusion
headache
wheezing and coughing
rapid breathing
Explanation:
Water intoxication is a serious adverse reaction that can occur with IV oxytocin administration, especially if the drug is administered continuously. The nurse immediately reports any signs of water intoxication that include drowsiness, confusion, headache, listlessness, wheezing, coughing, and rapid breathing. Increased blood sugar levels are not related to the use of oxytocin, however a rise in the serum level can be seen during labor as a result of the body's stress response. Although not urgent, the nurse should note this change in the patient's status and monitor.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544.

Chapter 46: Uterine Drugs - Page 544

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sweating
hypotension
depressed reflexes
flaccid paralysis
Explanation:
Adverse reactions to magnesium related to hypocalcemia induced by the therapy are sweating, hypotension, depressed reflexes, and flaccid paralysis. Uterine stimulants such as oxytocin are most likely to cause temporary chest pain as an adverse reaction to the medication.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546.

Chapter 46: Uterine Drugs - Page 546

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indocin
Explanation:
Indocin is used for preterm labor before 31 weeks' gestation. It can be given rectally and then orally for a total of 8 doses. Carboprost, misoprostol and oyxtocin are used to induce, not prevent, uterine contractions.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 549.

Chapter 46: Uterine Drugs - Page 549

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magnesium.
Explanation:
The health care provider will more than likely order magnesium to stop the labor. The other drugs listed are oxytocics, which are used to initiate labor or control postpartum bleeding, uterine atony, or hemorrhage.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 549.

Chapter 46: Uterine Drugs - Page 549

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Headache
Confusion
Coughing
Explanation:
Signs of water intoxication include drowsiness, confusion, headache, listlessness, wheezing, coughing, or rapid breathing. Anxiety and low respiratory rate are not signs of water intoxication.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544.

Chapter 46: Uterine Drugs - Page 544

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Placenta previa
Cephalopelvic disproportion
Hypertonic uterus
Explanation:
Oxytocin is contraindicated in cephalopelvic disproportion, unfavorable fetal position, severe preeclampsia, eclampsia, hypertonic uterus, and placenta previa. It is indicated for early delivery of a woman with a large fetus, Rh problems, premature rupture of membranes, and uterine inertia.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, pp. 543-544.

Chapter 46: Uterine Drugs - Page 543-544

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Provide supplemental oxygen.
Stop the oxytocin infusion.
Explanation:
If hypertonic uterine contractions are noted, the nurse should immediately stop the oxytocin infusion, provide supplemental oxygen, and turn the woman on her left side. Carboprost is not used until after delivery of the placenta. The nurse does not prepare for immediate delivery of the fetus, rather takes steps to make sure that the fetus has handled the hypertonic contractions.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 545.

Chapter 46: Uterine Drugs - Page 545

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Prevent seizures
Explanation:
Magnesium was once used to decrease uterine contractions but is now most commonly used to decrease the chance of seizures in clients with preeclampsia or eclampsia. It does not have any effect on the edema, headache, or protein in the urine.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 542.

Chapter 46: Uterine Drugs - Page 542

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Sweating
Flaccid paralysis
Double vision
Explanation:
Adverse reactions of magnesium include dizziness, double vision, nausea/ vomiting, sweating, hypotension, depressed reflexes, and flaccid paralysis.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546.

Chapter 46: Uterine Drugs - Page 546

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Place the client in the left lateral position.
Explanation:
When managing a client who is receiving a tocolytic, the nurse continuously monitors the client so that he or she may recognize hypotension. If it occurs, the client is placed in the left lateral position and the primary health care provider is notified because a dosage change may be necessary. The health care provider orders the administration of the medication and adjustments made using blood pressure and pulse parameters. The tocolytic is not stopped abruptly, not is a dose skipped. If the medication needs adjusted due to hypotension, decreasing the tocolytic will increase the blood pressure, so there would be no need to administer an antihypotensive drug.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 547.

Chapter 46: Uterine Drugs - Page 547

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depressed reflexes
Explanation:
Magnesium affects the neuromuscular system, so the nurse would assess mentation, cranial nerve function, and deep tendon reflexes. Depressed reflexes would be a cause for concern. Vasoconstriction can occur when methylergonovine (Methergine) is administered to a client who is a heavy smoker. The calcium channel blocker (nifedipine) and the beta2-adrenergic drug (terbutaline) are used to delay the delivery process for 24 to 48 hours. Sweating, hypotension, depressed reflexes, and flaccid paralysis are other adverse reactions associated with IV administration.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544.

Chapter 46: Uterine Drugs - Page 544

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Fetal heart rate (FHR)
Explanation:
When a client is taking terbutaline, the nurse should closely monitor the maternal heart rate, the FHR, and the maternal blood pressure and fluid status. The fetal position may be determined to assess the chances of successful delivery and the need to induce labor, but is not related to taking terbutaline.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544.

Chapter 46: Uterine Drugs - Page 544

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An increase in blood pressure
Explanation:
Methylergonovine is given orally three or four times a day beginning immediately postpartum for a maximum of 1 week. Hypertension, sometimes with seizures or headache, is the most common adverse effect. Tingling of the extremities and numbness are signs of acute overdose. Diarrhea is not associated with the use of the drug.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548.

Chapter 46: Uterine Drugs - Page 548

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Water intoxication
Explanation:
Oxytocin increases the water permeability of the nephron, which causes more water retention than sodium reabsorption and, in turn, leads to water intoxication. Symptoms of water intoxication primarily affect the CNS and musculoskeletal systems. Oxytocin infusions, when given to a client with autism or Asperger's disorder, result in a significant reduction in repetitive behaviors. Tachysystole and abnormal atrioventricular rhythms are not the cause of adverse effects.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548.

Chapter 46: Uterine Drugs - Page 548

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To prevent postpartum hemorrhage
Explanation:
Uterine stimulants increase the strength, duration, and frequency of uterine contractions and decrease the incidence of uterine bleeding. They are given after the delivery of the placenta and are used to prevent postpartum and postabortal hemorrhage caused by uterine atony.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543.

Chapter 46: Uterine Drugs - Page 543

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Water intoxication
Explanation:
Because of its antidiuretic effect, serious water intoxication (fluid overload, fluid volume excess) may occur, particularly when the drug is administered by continuous infusion and the client is receiving fluids by mouth.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 545.

Chapter 46: Uterine Drugs - Page 545

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Help with milk letdown in breastfeeding
Explanation:
Intranasal oxytocin is only used to stimulate the milk ejection (milk letdown) reflex to allow for successful breastfeeding. Oxytocin in the intranasal form is not used to cause contraction of the fundus, nor to control bleeding in the postpartum period. Oxytocin is only ever used to stimulate the uterus, not prevent, slow down or decrease the intensity of contractions.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543.

Chapter 46: Uterine Drugs - Page 543

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Blood pressure
Explanation:
Methylergonovine may cause hypertension, so the nurse must assess the client's blood pressure prior to administering this drug. The drug is not given routinely IV because it may produce sudden hypertension and stroke. If the drug is ordered IV, administer it slowly over a period of 1 minute or more with close monitoring of the patient's blood pressure. The other vital signs are important to assess, however with this medication specifically, the blood pressure is the priority.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548.

Chapter 46: Uterine Drugs - Page 548

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Vasopressin
Explanation:
Oxytocin is similar to the hormone vasopressin and has an antidiuretic effect. It is not similar to insulin, thyroid stimulating hormone, or parathyroid hormone.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543.

Chapter 46: Uterine Drugs - Page 543

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Excess fluid volume
Explanation:
There are numerous potentially adverse effects associated with the use of oxytocin. Paramount among these, however, is the risk of excess fluid volume and water intoxication. This risk supersedes the potential for respiratory, cognitive, or thermoregulatory problems.

Reference:
Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 545.

Chapter 46: Uterine Drugs - Page 545

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Which patients would a nurse determine Cannot safely receive oxytocin for labor induction?

Which of the following medications would be given to promote uterine relaxation?

For which administration route should the nurse prepare to administer misoprostol to a client for induction of labor?

Why is oxytocin prescribed to be given immediately after the third stage of labor?