CPM Certified Professional Midwife

Category - General Healthcare Skills

A 38-year-old client at 12 weeks’ gestation tested positive for gonorrhea. Which of the following actions by the midwife is the least appropriate for the client?
  1. Administer a single oral dose of azithromycin.
  2. Administer a single dose of ceftriaxone through the IM route.
  3. Instruct the client to avoid sexual contact until the infection is cured.
  4. Administer a single dose ciprofloxacin through the IM route.
Answer: D - Administering a single dose of ciprofloxacin through the IM route is the least appropriate intervention for the client. Fluoroquinolones, such as ciprofloxacin and ofloxacin, should not be used to treat gonococcal infections in pregnant clients. These medications may inhibit proper formation of the DNA and may cause birth defects. Ceftriaxone is administered to treat Neisseria gonorrhoeae. Chlamydia infections commonly co-occur with gonococcal infections, so azithromycin should also be administered. Ceftriaxone and azithromycin are considered pregnancy Category B medications. Medications in this category have failed to demonstrate risks to the fetus, but there are no well-controlled studies in pregnant females. These medications must only be given if the benefits outweigh the risks. Untreated gonococcal infections in pregnant clients may cause miscarriage, infection of the amniotic sac and fluid and pre-term premature rupture of the membranes.
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