A physician has written an order to administer Methergine to a postpartum client with uterine atony. The nurse would contact the physician to verify the order if which of the following conditions were present in the mother?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

Methergine (methylergonovine) is an ergot alkaloid that causes potent vasoconstriction in addition to uterine contraction.
Administering a vasoconstrictor to a person who is already hypertensive can lead to a dangerous spike in blood pressure.
This increased blood pressure can result in severe complications such as a hypertensive crisis, stroke, or seizure.
Therefore, hypertension is a primary contraindication for the use of Methergine, and the nurse has a duty to question the order.

Option B: Excessive lochia is a sign of uterine atony and postpartum hemorrhage.
Option C: Difficulty locating the uterine fundus suggests a soft, boggy, and atonic uterus.
Option D: Excessive bleeding (saturating more than one peripad per hour) is a hallmark of postpartum hemorrhage, often due to uterine atony.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacology: Contraindications of Uterotonic Medications to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary responsibility before administering Methergine is to check the client's blood pressure. A reading greater than 140/90 mmHg requires holding the medication and notifying the provider.
Failure to recognize this contraindication can lead to severe maternal harm, including cerebrovascular accident (stroke) or eclamptic seizures.
This scenario highlights the nurse's crucial role as a patient safety advocate, responsible for verifying medication orders that may be inappropriate based on the client's current clinical status.

How to Approach the Question

First, identify the core of the question: it asks for a contraindication to the drug Methergine.
Recall the drug class and primary action of Methergine (methylergonovine). It is an ergot alkaloid that causes uterine contraction.
Crucially, remember its major side effect/contraindication. Methergine is a potent vasoconstrictor.
Analyze the options. Three options (B, C, D) describe signs of uterine atony and postpartum hemorrhage: excessive lochia, a boggy uterus, and heavy bleeding.
Recognize that these three options are indications for the drug, as Methergine is used to treat uterine atony.
Identify the remaining option, Hypertension, as the contraindication. A vasoconstrictor should not be given to someone with high blood pressure.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 49-70

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.