Practice Quiz

CNM Certified Nurse Midwife

Category - Antepartum

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A client at 11 weeks’ gestation complains of severe and extreme nausea and vomiting. During history taking, the nurse midwife learns that the client vomits at least three times a day. An ultrasound is performed and reveals that the client is negative for hydatidiform mole and multiple pregnancy. The nurse midwife suspects a case of hyperemesis gravidarum. The client is admitted for monitoring. Which of the following interventions is the least appropriate for the client?
  1. Increase oral intake of fluids.
  2. Administer 3,000 mL of Ringer’s lactate.
  3. Administer metoclopramide.
  4. Monitor fluid intake and urinary output.
Explanation
Answer: A - During monitoring for hyperemesis gravidarum, oral fluids are usually withheld for the first 24 hours. If there is no vomiting after the first 24 hours, the client may have small amounts of clear fluids. Intravenous Ringer’s lactate is administered, usually with vitamin B1 to increase hydration during monitoring. The nurse midwife may also administer metoclopramide, an anti-emetic. Research has shown that this medication is not linked to congenital anomalies. Fluid intake and urinary output must be monitored to assess the blood volume.
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