Maternal and Newborn Medications
A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which finding is noted on assessment? a) Proteinuria of 3 + b) Respirations of 10 breaths/minute c) Presence of deep tendon reflexes d) Serum magnesium level of 6 mEq/L
ANS. b) Respirations of 10 breaths/minute Rationale: Magnesium toxicity can occur from magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden decline in fetal heart rate and maternal heart rate and blood pressure. Therapeutic serum levels of magnesium are 4 to 7.5 mEq/L. Proteinuria of 3 + is an expected finding in a client with preeclampsia.
The nurse is monitoring a client who is receiving oxytocin (Pitocin) to induce labor. Which assessment finding would cause the nurse to immediately discontinue the oxytocin infusion? a) Fatigue b) Drowsiness c) Uterine hyperstimulation d) Early decelerations of the fetal heart rate
ANS. c) Uterine hyperstimulation Rationale: Oxytocin stimulates uterine contractions and is a common pharmacological method to induce labor. High-dose protocols have been associated with more uterine hyperstimulation and more cesarean births related to fetal stress. Some health care providers prescribe the administration of oxytocin in 10-minute pulsed infusions rather than as a continuous infusion. This pulsed method, which is more like endogenous secretion of oxytocin, is reported to be effective for labor induction and requires significantly less oxytocin use. Adverse effects associated with administration of the medication are hyperstimulation of uterine contractions and nonreassuring fetal heart rate patterns. Oxytocin infusion must be stopped when any signs of uterine hyperstimulation are present. Drowsiness and fatigue may be caused by the labor experience. Early decelerations of the fetal heart rate are a reassuring sign and do not indicate fetal distress.
Rho(D) immune globulin (RhoGAM) is prescribed for a client after delivery and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose if the woman states that it will protect her next baby from which condition? a) Having Rh-positive blood b) Developing a rubella infection c) Developing physiological jaundice d) Being affected by Rh incompatibility
ANS. d) Being affected by Rh incompatibility Rationale: Rh incompatibility can occur when an Rh-negative mother becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the fetus's Rh-positive blood can enter the maternal circulation, causing the mother's immune system to form antibodies against Rh-positive blood. Administration of Rho(D) immune globulin (RhoGAM) prevents the mother from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen.
Methylergonovine (Methergine) is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse contacts the health care provider who prescribed the medication if which condition is documented in the client's medical history? a) Hypotension b) Hypothyroidism c) Diabetes mellitus d) Peripheral vascular disease
ANS. d) Peripheral vascular disease Rationale: Methylergonovine is an ergot alkaloid used to treat postpartum hemorrhage. Ergot alkaloids are contraindicated in clients with significant cardiovascular disease, peripheral vascular disease, hypertension, preeclampsia, or eclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. Options 1, 2, and 3 are not contraindications related to the use of ergot alkaloids.
A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate and contractions have stopped. If the client's labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication? a) Nalbuphine (Nubain) b) Betamethasone (Celestone) c) Rho(D) immune globulin (RhoGAM) d) Dinoprostone (Cervidil vaginal insert)
ANS. b) Betamethasone (Celestone) Rationale: Betamethasone, a glucocorticoid, is given to increase the production of surfactant to stimulate fetal lung maturation. It is administered to clients in preterm labor at 28 to 32 weeks of gestation if the labor can be inhibited for 48 hours. Nalbuphine (Nubain) is an opioid analgesic. Rho(D) immune globulin (RhoGAM) is given to Rh-negative clients to prevent sensitization. Dinoprostone (Cervidil vaginal insert) is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions.
The nursing instructor asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which student statement indicates that further teaching is needed? a) "I will flush the eyes after instilling the ointment." b) "I will clean the newborn's eyes before instilling ointment." c) "I need to administer the eye ointment within 1 hour after delivery." d) "I will instill the eye ointment into each of the newborn's conjunctival sacs."
ANS. a) "I will flush the eyes after instilling the ointment." Rationale: Eye prophylaxis protects the newborn against Neisseria gonorrhoeae and Chlamydia trachomatis. The eyes are not flushed after instillation of the medication because the flush would wash away the administered medication. Options 2, 3, and 4 are correct statements regarding the procedure for administering eye medication to the newborn.
Methylergonovine (Methergine) is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority nursing assessment? a) Uterine tone b) Blood pressure c) Amount of lochia d) Deep tendon reflexes
ANS. b) Blood pressure Rationale: Methylergonovine, an ergot alkaloid, is used to prevent or control postpartum hemorrhage by contracting the uterus. Methylergonovine causes continuous uterine contractions and may elevate the blood pressure. A priority assessment before the administration of the medication is to check the blood pressure. The health care provider should be notified if hypertension is present. Although options 1, 3, and 4 may be components of the postpartum assessment, the correct option, blood pressure, is related specifically to the administration of this medication.
An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily available if respiratory depression occurs? a) Naloxone b) Morphine sulfate c) Betamethasone (Celestone) d) Meperidine hydrochloride (Demerol)
ANS. a) Naloxone Rationale: Opioid analgesics may be prescribed to relieve moderate to severe pain associated with labor. Opioid toxicity can occur and cause respiratory depression. Naloxone is an opioid antagonist, which reverses the effects of opioids and is given for respiratory depression. Morphine sulfate and meperidine hydrochloride are opioid analgesics. Betamethasone is a corticosteroid administered to enhance fetal lung maturity.
The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? Select all that apply. a) Flushing b) Hypertension c) Increased urine output d) Depressed respirations e) Extreme muscle weakness f) Hyperactive deep tendon reflexes
ANS. a, d, e Rationale: Magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus. It is used to halt preterm labor contractions and is used for preeclamptic clients to prevent seizures. Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.
The nurse is preparing to administer beractant (Survanta) to a premature infant who has respiratory distress syndrome. The nurse plans to administer the medication by which route? a) Intradermal b) Intratracheal c) Subcutaneous d) Intramuscular
ANS. b) Intratracheal Rationale: Respiratory distress syndrome is a serious lung disorder caused by immaturity and the inability to produce surfactant, resulting in hypoxia and acidosis. It is common in premature infants and may be due to lung immaturity as a result of surfactant deficiency. The mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route. Options 1, 3, and 4 are not routes of administration for this medication.
