The graduate nurse (GN) is admitting a client for labor induction who is prescribed misoprostol for cervical ripening. Before misoprostol is administered, which of the following statements by the GN should be concerning to the supervising nurse? Select all that apply.

Question

Quizplus · Accepted Answer

Misoprostol (Cytotec), a prostaglandin E1, is a cervical ripening agent. Cervical ripening is a process that normally occurs before the onset of labor in which the cervix softens and becomes more pliable so that dilation and effacement can occur more easily during contractions. Mechanical or pharmacologic cervical ripening methods simulate this process and increase the client's probability of achieving a vaginal birth. In addition to ripening the cervix, prostaglandins (eg, misoprostol, dinoprostone) can stimulate frequent contractions. Therefore, administration of misoprostol is contraindicated if: the client is receiving another uterotonic simultaneously (eg, oxytocin) (Option A). the client has a history of uterine surgery (eg, cesarean birth) due to an increased risk of uterine rupture at the surgical scar site (Option B). the client has an abnormal fetal heart rate pattern or uterine tachysystole (ie, >5 contractions in 10 min) (Option D). (Option C) A client with this cervical examination would especially benefit from cervical ripening because it may reduce the amount of oxytocin required later in the labor induction process (oxytocin administered at least 4 hr after last misoprostol dose if needed); less oxytocin reduces postpartum hemorrhage (PPH) risk. (Option E) The health care provider prescribes misoprostol orally or vaginally for labor induction. Rectal administration is only appropriate during PPH. Educational objective: Misoprostol (Cytotec) is a cervical ripening agent administered orally or vaginally. It is contraindicated in clients who are receiving another uterotonic simultaneously (eg, oxytocin), have had previous uterine surgery (eg, cesarean birth), or have abnormal fetal heart rate patterns or uterine tachysystole.

The Graduate Nurse (GN) Is Admitting a Client for Labor