NCLEX-PN

Category - Pharmacological Therapies

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A nurse is monitoring a client in labor who is receiving methylergonovine maleate (Methergine) IV. The nurse’s priority assessment when monitoring the client is:

Blood pressure measurement
Level of consciousness
Urinary output per hour
Respiratory rate

Explanation

Answer: A - Methylergonovine maleate is administered to prevent or control labor. The nurse’s priority assessment is to monitor the client’s blood pressure. Severe hypertension is a potential adverse reaction.

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