A nurse is preparing to administer methylergonovine to a client who is 2 hr postpartum and has a boggy fundus. Which of the following findings should the nurse identify as a contraindication to this medication?

Methylergonovine is an ergot alkaloid used to manage postpartum hemorrhage by inducing firm, sustained uterine contractions. It acts directly on the uterine smooth muscle but also possesses significant vasoconstrictive properties. Because it can cause a rapid and dangerous rise in systemic vascular resistance, it is strictly contraindicated in patients with hypertensive disorders. Rationale: A. Lochia rubra is the normal, bloody vaginal discharge observed in the immediate postpartum period and is not a contraindication for methylergonovine. In fact, if the lochia is excessive due to uterine atony (a boggy fundus), methylergonovine is indicated to stop the bleeding. The medication helps transition the uterus to a firm state, which actually reduces the volume of lochia rubra. B. A blood pressure of 190/110 mm Hg is a critical contraindication because methylergonovine causes systemic arterial vasoconstriction. Administering this medication to a hypertensive patient could lead to a stroke, myocardial infarction, or seizure. The nurse must withhold the dose and notify the provider, as this drug can exacerbate pre-eclampsia or chronic hypertension to life-threatening levels. C. A distended bladder can cause the uterus to become boggy by displacing it upward and to the side, but it does not contraindicate methylergonovine. While the nurse should encourage the patient to void to allow for natural uterine contraction, the presence of a full bladder does not make the drug unsafe. Clinical priority involves emptying the bladder to accurately assess fundal tone. D. A urinary output of 60 mL/hr is a normal physiological finding and indicates adequate renal perfusion in the postpartum patient. There is no pharmacological reason to withhold methylergonovine based on this healthy urine volume. The nurse should continue to monitor output, but 60 mL/hr suggests the patient is hemodynamically stable and capable of clearing medications through the kidneys.