Health Promotion and Maintenance
6. A client who is a 23-year-old primigravida is admitted for induction of labor for macrosomia. Upon assessment, an RN notes the client is having contractions every 2 minutes, lasting 60 seconds in duration. A physician orders misoprostol 25 mcg to be placed in the posterior fornix of the vagina. Which action should be taken by the RN?
. Call the physician to clarify the dosage of misoprostol.
. Perform a vaginal exam to determine dilation and place the misoprostol as ordered by the physician.
. Withhold the dosage and notify the physician of contraction pattern.
. Withhold the dosage of misoprostol due to the risks associated with macrosomia.
Test-Taking Tip
Consider that misoprostol cannot be removed once it is given vaginally and the contractions caused by the medication can result in uterine hyperstimulation. Focus on the two options that state: do not give ("withhold").
Content Area: Maternity, Intrapartum; Integrated Process: Nursing Process, Implementation; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Adverse Effects/Contraindications/Interactions
Health Promotion and Maintenance
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Answer 1 is incorrect because this is an appropriate dosage of misoprostol for induction of labor; no clarification is needed for this order. Answer 2 is incorrect because this client is already having very frequent uterine contractions and placing misoprostol is contraindicated for this client. Answer 3 is correct because this client is having very frequent uterine contractions and placing misoprostol is contraindicated for this client. The physician should be notified of the contraction pattern and withholding the misoprostol dose. Answer 4 is incorrect because macrosomia is an indication for induction of labor; however, this client is not a candidate for placement of misoprostol due to the frequency of her uterine contractions.