Question

A nurse at a provider's office is caring for a client who is 28 years of age.

The nurse is collaborating with another nurse about the client's plan of care. For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client.

History and Physical
Day 1 at 1000:
Gravida 3, Para 2, Abortion 1
Asthma (managed with levalbuterol inhaler as needed)
Pelvic inflammatory disease (PID)
Spontaneous vaginal delivery X 2 (hypertension with first pregnancy at 20 years of age)
Voluntary termination of pregnancy (3rd pregnancy)

Nurses' Notes
Day 1 at 1000:
Client presents to the office with concerns of late menses, abdominal pain, and scant dark red vaginal spotting. Client reports menstrual period is usually regular and is 2 weeks late. Last menstrual period: 2/20/XX. Client reports occasional dull abdominal pain and rates it as 2 on a 0 to 10 pain scale. Client is alert and oriented, appears anxious. Speech clear. Skin warm and dry to touch. Heart rate regular at 90/min. Respirations even and non-labored. Lungs slight inspiratory wheezes. Bowel sounds hyperactive in all four quadrants. Abdomen tender to touch right lower quadrant. Perineal pad with scant amount of dark red vaginal spotting.

Vital Signs
Day 1 at 1000:
Temperature 37.2° C (98.9° F), Heart rate 90/min, Respirations 16/min, Blood pressure 120/74 mm Hg, Oxygen saturation 97% room air
Day 1 at 1030:
Temperature 37.2° C (98.9° F), Heart rate 104/min, Respirations 18/min, Blood pressure 116/70 mm Hg, Oxygen saturation 97% room air

Diagnostic Results
Day 1 at 1015:
Urine human chorionic gonadotropin (HCG) positive (negative)
Day 1 at 1030:
Blood human chorionic gonadotropin (hCG) 50 IU/L (less than 5 IU/L)
Quantitative beta human chorionic gonadotropin (β-hCG) 20,000 IU/L (negative)
Progesterone 4 ng/dL (1st trimester 725 to 4400 ng/dL)
Hgb 11 g/dL (12 to 16 g/dL)
Hct 35% (37 to 47%)
Platelets 152,000/mm3 (150,000 to 300,000/mm3)


Anticipated or Contraindicated

Potential Order
A. Transvaginal ultrasound
B. Meperidine IM
C. Repeat quantitative Beta-hCG level
D. Methotrexate IM
E. Blood typing

Answer 1

The nurse anticipates a transvaginal ultrasound and blood typing for the client. Meperidine and Methotrexate are contraindicated due to the client's medical history.

Step-by-step explanation:

The potential prescription of Transvaginal ultrasound is anticipated for the client. This is because the client is presenting with symptoms such as late menses, abdominal pain, and vaginal spotting, which could indicate pregnancy or other gynecological issues. A transvaginal ultrasound is a noninvasive procedure that can help visualize the reproductive organs and provide important information for diagnosis and treatment planning.

The potential prescription of Meperidine IM is contraindicated for the client. Meperidine is an opioid medication that is commonly used for pain relief. However, this client has a history of asthma, and opioids can cause respiratory depression and worsen asthma symptoms. Therefore, it is not recommended for this client.

The potential prescription of Repeat quantitative Beta-hCG level is anticipated for the client. Given the client's symptoms and the positive urine and blood human chorionic gonadotropin (hCG) levels, repeating the quantitative Beta-hCG level can help monitor the progression of the pregnancy and assess the viability of the pregnancy.

The potential prescription of Methotrexate IM is contraindicated for the client. Methotrexate is a medication used for various conditions, including ectopic pregnancy. However, in this case, the client's quantitative Beta-hCG level is 20,000 IU/L, which indicates a high level of hCG and is not consistent with an ectopic pregnancy. Additionally, the client has no specific indication for Methotrexate at this point.

The potential prescription of Blood typing is anticipated for the client. Blood typing is a routine part of prenatal care and helps determine the client's blood type and Rh factor. This information is crucial in case a blood transfusion or Rh immune globulin administration is necessary during pregnancy to prevent complications.