Medication Quiz Fall 2022

A pregnant patient is administered misoprostol (Cytotec) to induce labor. After 8 hours of drug administration, the patient develops diarrhea and vomiting. What does the nurse do to alleviate the symptoms? A. Administer terbutaline (Brethine). B. Administer oxytocin (Pitocin) infusion. C. Give a magnesium containing antacid. D. Increase the time between doses

A - Administer terbutaline (Brethine)

What is the difference between dexamethasone (Decadron) and desoximetasone (Topicort)? A. Dexamethasone (Decadron) accelerates fetal lung maturity, whereas desoximetasone (Topicort) treats inflammation. B. Dexamethasone (Decadron) prevents respiratory distress in infants, whereas desoximetasone (Topicort) causes respiratory distress in infants. C. Dexamethasone (Decadron) is a corticosteroid, whereas desoximetasone (Topicort) is a beta2-adrenergic agonist. D. Dexamethasone (Decadron) is used for mild preeclampsia, whereas desoximetasone (Topicort) is used for severe preeclampsia

A - Dexamethasone (Decadron) accelerates fetal lung maturity, whereas desoximetasone (Topicort) treats inflammation Dexamethasone (Decadron) is an antenatal corticosteroid that accelerates fetal lung maturity. Desoximetasone (Topicort) treats inflammation. Dexamethasone prevents respiratory distress in infants, but desoximetasone does not cause respiratory distress. Both dexamethasone and desoximetasone are corticosteroids. Neither medication is used for the treatment of preeclampsia.

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: A. Hydralazine. B. Magnesium sulfate bolus. C. Diazepam. D. Calcium gluconate.

A - Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP over 160 mm Hg or a diastolic BP over 110 mm Hg. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops.Diazepam sometimes is used to stop or shorten eclamptic seizures.Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The woman is not currently displaying any signs or symptoms of magnesium toxicity.

Which drug is administered after delivery to reduce the risk of postpartum hemorrhage after the placenta has been delivered? A. Oxytocin (Pitocin) B. Magnesium sulfate C. Vitamin K D. Dopamine

A - Oxytocin (Pitocin) Uterine stimulants, primarily oxytocin, given in low dose infusions after delivery of the fetus and placenta, help stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus. Magnesium sulfate is given to treat eclampsia and preeclampsia. Vitamin K is given to prevent hemorrhage. Dopamine is given to treat hypotension.

The traditional diet of Asian women includes little meat and few dairy products and may be low in calcium and iron. The nurse can assist a patient increase her intake of these foods by which action? A. Suggest that she eat more tofu, bok choy, and broccoli. B. Suggest that she eat more hot foods during pregnancy. C. Emphasize the need for increased milk intake during pregnancy. D. Tell her husband that she must increase her intake of fruits and vegetables for the baby's sake.

A - Suggest that she eat more tofu, bok choy, and broccoli.The diet should be improved by increasing foods acceptable to the woman. These foods are common in the Asian diet and are good sources of calcium and iron. Pregnancy is considered hot; therefore the woman would eat cold foods. Because milk products are not part of this woman's diet, it should be respected and other alternatives offered. Also, lactose intolerance is common. Fruits and vegetables are cold foods and should be included in the diet. In regard to the family dynamics, however, the husband does not dictate to the wife in this culture

The nurse observes that a pregnant patient who is taking terbutaline (Brethine) treatment has a heart rate of 135 beats/min. Which medication administration does the nurse expect the primary health care provider (PHP) to order? A. Intravenous (I.V.) propranolol (Inderal) B. 1 g I.V. calcium gluconate C. Oral dose of 20 mg of nifedipine (Adalat) D. 500 mg of I.V. calcium chloride for 30 minutes

A - Terbutaline (Brethine) is a beta-adrenergic agonist that is used as a tocolytic to reduce uterine contractions (UCs) in preterm labor. The patient has a heart rate of 135 beats/min, which implies that the patient has intolerance to the drug and has tachycardia. Therefore the patient should be administered a beta-adrenergic blocker, such as propranolol (Inderal), to reverse the adverse effects of terbutaline (Brethine). Administering calcium gluconate, nifedipine (Adalat), and calcium chloride does not help to reduce the adverse effects of terbutaline (Brethine) in the patient. Rather, 1 g of calcium gluconate and 500 mg of calcium chloride are administered in case of magnesium sulfate toxicity. Nifedipine (Adalat) is a calcium channel blocker, which should not be given after terbutaline (Brethine) because it affects the patient's heart rate and blood pressure.

The nurse is caring for a pregnant patient who has been prescribed terbutaline (Brethine) to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline (Brethine) to the patient. Which patient condition leads the nurse to such a conclusion? A. Blood pressure of 80/60 mm Hg B. Short episode of hyperglycemia C. Irregular episodes of dysrhythmias D. Heart rate of less than 120 beats/min

A - Terbutaline (Brethine) relaxes the smooth muscles and inhibits uterine activity (UA). However, the drug can adversely affect the cardiovascular system. Presence of a blood pressure lower than 90/60 mm Hg indicates an adverse effect on the cardiovascular system, and the nurse should stop the treatment to prevent further damage. Short and irregular episodes of hyperglycemia and dysrhythmias are mild and tolerable adverse effects of terbutaline (Brethine), so those conditions would not warrant the discontinuation of the medication. If the patient develops tachycardia greater than 130 beats/min, then the treatment should be stopped.

A 30-year-old woman with hypertension is currently on an ACE inhibitor but has just discovered she is pregnant. Knowing that ACE inhibitors are teratogenic, you decide to switch her to a different medication for her HTN. What medications are commonly used in the managment of chronic hypertension in pregnancy?

"Hypertensive Mothers Love Nifedipine" -Hydralazine -Methyldopa -Labetalol -Nifedipine

Terbutaline dosage as tocolytic:

10mcg/min IV infusion/1VPB, titrate to effects (80mcg/min max) with O2 before and during administration. Pregnancy safety - B

What is the duration of magnesium sulfate therapy for a Pre-term labor patient?

12-24 hours after contractions cease and/or after oral tocolytic therapy is started, per physician order.

What is the maintenance dose of magnesium sulfate?

2 grams of magnesium sulfate per hour

What is the rate that a 4gm loading dose of Magnesium Sulfate should be delivered?

4 grams in 100 ml over 30 minutes. rate of 200 ml/h

What is the loading dose of Magnesium Sulfate?

4 grams of magnesium sulfate in 100 ml fluid for IVPB

While caring for a patient who is treated with terbutaline (Brethine), the nurse tries to reduce pressure on the patient's cervix to prevent preterm labor. Which nursing action would be most relevant? A. Suggesting that the patient lie on her side B. Infusing Ringer's lactate solution intravenously C. Increasing the terbutaline (Brethine) concentration D. Encouraging drinking a full glass of water periodically

A - The nurse should suggest that the patient lie on her side, because this enhances placental perfusion and reduces the pressure on the cervix. Ringer's lactate solution is infused when amniotic fluid levels are lowered in a pregnant patient. Water intake prevents dehydration during labor, but it does not reduce pressure on the cervix. Nurses should not increase the terbutaline (Brethine) concentration. This may cause adverse effects and can be fatal to the mother and the fetus.

The nurse administers hydralazine IV to control the blood pressure of a woman diagnosed with preeclampsia. If the nurse administered this medication at 0800, the next assessment of blood pressure should occur at: A. 0803 B. 0815 C. 0830 D. 1000

A - The vasodilator hydralazine is usually administered to control blood pressure. If IV has been given, monitor the maternal and fetal heart rates and the mothers blood pressure 2 to 3 minutes after the initial dose and every 10 to 15 minutes thereafter.

It is determined that a client's blood Rh is negative and her partner's is Rh positive. To help prevent Rh isoimmunization, the nurse would expect to administer Rho(D) immune globulin at which time? A. at 28 weeks' gestation and again within 72 hours after birth B. in the first trimester and within 2 hours of birth C. at 32 weeks' gestation and immediately before discharge D. 24 hours before birth and 24 hours after birth

A - at 28 weeks' gestation and again within 72 hours after birthTo prevent isoimmunization, the woman should receive Rho(D) immune globulin at 28 weeks and again within 72 hours after birth.

What are the mechanisms of action for terbutaline? Select all that apply. A. Relax bronchial smooth muscle B. Reverse bradycardia C. Relax uterine smooth muscle to inhibit contractions D. Bronchodilation for decreased airway resistance E. Increased effacement of cervix

A,C,D - Relax bronchial smooth muscle, relax uterine smooth muscle to inhibit contractions, bronchodilation for decreased airway resistance.

A patient at 33 weeks gestation is admitted to the obstetric unit in active labor with symptoms associated with pregnancy induced hypertension (PIH). Which action(s) will the nurse implement? (Select all that apply.) a. Vital signs hourly b. Administration of IV pitocin c. Administration of magnesium sulfate IV d. Fetal stress teste. Assessment of deep tendon reflexes

A, C, D, E - Important nursing assessments and/or interventions include monitoring of vital signs and level of consciousness continuously, continuous fetal monitoring with stress tests and external or internal fetal monitoring, and deep tendon reflexes. IV magnesium sulfate is often prescribed for patients with PIH. Oxytocin increases uterine contractions and is contraindicated in preterm labor.

A pregnant patient does not drink milk because of lactose intolerance. Which foods should the nurse instruct the patient to incorporate in her diet to prevent calcium deficiency? Select all that apply. A. Sardines B. Avocadoes C. Cooked pasta D. Wheat breadE. Refried beans

A, E - Canned sardines and refried beans are rich sources of calcium. Therefore a diet containing these foods should be suggested for patients who do not drink milk. Avocado, cooked pasta, and bread have poor calcium content. These foods are rich sources of folic acid and are suggested to pregnant patients to increase folate levels.

The nurse is caring for a pregnant patient who had an onset of labor during 34 weeks' gestation. What does the nurse expect the primary health care provider (PHP) to prescribe? Select all that apply. A. Antibiotics B. Glucocorticoids C. Synthetic oxytocin D. Magnesium sulfate E. Progesterone supplementations

A,B - The onset of labor during 34 weeks' gestation indicates that the patient has preterm labor. In such a condition, antibiotics and glucocorticoids should be prescribed and administered to the patient. Antibiotics are prescribed to prevent neonatal group B streptococcal infection. Glucocorticoids are prescribed to reduce the neonatal morbidity and mortality. Synthetic oxytocin is administered in patients to induce labor. Therefore synthetic oxytocin will not be prescribed to the patient because of the onset of labor. Magnesium sulfate is administered when the labor is induced before 32 weeks' gestation. Progesterone supplementation is administered before the onset of labor to prevent preterm birth.

What are some side effects of magnesium sulfate? Select all that apply. A. Flushing B. Muscle weakness C. Tachycardia D. Blurred vision E. Respiratory depression

A,B,D,E - Also, headache, lethargy, nausea/vomiting and bradycardia not tachycardia.

What are some of the side effects of terbutaline? Select all that apply. A. Tachydysrythmias B. Hypotension C. Headache D. Dizziness E. PVCs

A,C,D,E - Tachydysrythmias, headache, dizziness, PVCs, along with anxiety, N/V and hypertension not hypotension

The nurse is preparing to administer terbutaline (Brethine) to a pregnant patient who is in preterm labor. What questions should the nurse ask the patient before drug administration to promote drug safety? Select all that apply. A. "Do you ever have migraine headaches?" B. "Do you have pregnancy-induced diabetes?" C. "Do you suffer from nausea and vomiting?" D. "Do you suffer from any cardiac disease?" E. "Do you experience urinary frequency?

A. "Do you ever have migraine headaches?" B. "Do you have pregnancy-induced diabetes?" D. "Do you suffer from any cardiac disease?" Also, use caution with patients who have history of hypertension, dysrhythmias and glaucoma.

The nurse tells the primary health care provider (PHP) that there is 15 mL of fetal blood in maternal circulation, as detected by Kleihauer-Betke test, in an Rh-negative patient. What does the nurse expect the PHP to prescribe to this patient? A. 300 mcg of intramuscular Rh immune globulin B. 400 mcg of intramuscular Rh immune globulin C. 100 mcg of intramuscular Rh immune globulin D. 200 mcg of intramuscular Rh immune globulin

A. 300 mcg of intramuscular Rh immune globulin

The nurse is caring for a patient who is pregnant who is expected to experience preterm labor. The laboratory reports indicate that the fetus's lungs are not completely developed. Which adrenal drug will the nurse expect to be most beneficial for the patient? A. Betamethasone (Celestone) B. Dexamethasone (Decadron) C. Aminoglutethimide (Cytadren) D. Methylprednisolone (Solu-Medrol)

A. Betamethasone (Celestone) Betamethasone (Celestone) is a synthetic glucocorticoid and the drug of choice to enhance fetal lung maturation. This medication is given to patients who may experience preterm labor since it accelerates fetal lung maturation and prevents respiratory infections in newborns. Dexamethasone (Decadron) is also a synthetic glucocorticoid but is less beneficial than betamethasone (Celestone). Aminoglutethimide (Cytadren) is a pregnancy category D drug. It is an antiadrenal drug and may not be effective for enhancing fetal lung maturation. This medication may also cause teratogenic effects. Methylprednisolone (Solu-Medrol) is an injectable glucocorticoid drug. It is used to treat hyperemesis gravidarum and does not accelerate fetal lung maturation.

Which corticosteroids stimulate lung surfactant development in the fetus in utero? Select all that apply. A. Methylergonovine (Methergine) B. Betamethasone (Celestone) C. Dexamethasone (Decadron) D. Desoximetasone (Topicort) E. Terbutaline sulfate (Brethine

A. Betamethasone (Celestone) C. Dexamethasone (Decadron) Betamethasone (Celestone) and Dexamethasone (Decadron) are antenatal corticosteroids that help in the lung surfactant development in the fetus in utero. Methylergonovine (Methergine) stimulates uterine contractions. Desoximetasone (Topicort) treats inflammation. Terbutaline sulfate (Brethine) inhibits uterine contractions during preterm labor.

The nurse is preparing to administer dexamethasone (Decadron) to a pregnant patient. Which nursing intervention should the nurse perform for safe administration of the drug? Select all that apply. A. Inform the patient that it will be painful. B. Administer the oral form if patient refuses injection. C. Administer the drug by intramuscular injection. D. Monitor blood pressure of the patient. E. Assess blood glucose levels in the patient.

A. Inform the patient that it will be painful. C. Administer the drug by intramuscular injection. E. Assess blood glucose levels in the patient.

A patient at 33 weeks' gestation has presented with preterm premature rupture of the membranes. On examination, the nurse determines the FHR is 100 bpm and the umbilical cord has prolapsed. What is the next action by the nurse? A. Notify the practitioner and prepare for an emergency cesarean birth. B. Quickly administer a dose of betamethasone and prepare for an emergency cesarean birth. C. Administer a dose of betamethasone and recheck the FHR. D. Administer a dose of betamethasone and notify the practitioner.

A. Notify the practitioner and prepare for an emergency cesarean birth.

A patient at 30 weeks' gestation has been receiving magnesium sulfate therapy for tocolysis. The patient received betamethasone 24 hours ago and is due for a second injection. Following the initial assessment, the patient reports a sensation of heaviness in the chest. What should the nurse do first? A. Notify the practitioner because this symptom may indicate pulmonary edema. B. Administer the betamethasone before the patient goes into active labor. C. Reassure the patient that this symptom is caused by the baby pushing on the ribs. D. Reassure the patient that this symptom is a normal adverse effect of the patient's medications.

A. Notify the practitioner because this symptom may indicate pulmonary edema.

The nurse is advising a lactose-intolerant pregnant patient about calcium intake. Which calcium sources are approximately equivalent to 1 cup of milk? (Select all that apply.) A. cup yogurt B. 1 cup of sherbet C. oz of hard cheese D. cups of ice cream E. cup of low-fat cottage cheese

A. cup yogurt C. oz of hard cheese D. cups of ice cream Calcium sources approximately equivalent to 1 cup of milk include cup yogurt, ounce of hard cheese, and cups of ice cream. It takes 3 cups of sherbet and cups of low-fat cottage cheese to equal the calcium equivalent of 1 cup of milk.

What to assess when during magnesium sulfate therapy:

Assess P, R, and BP every 15 minutes first hour of infusion and following any dosage increase. every 30 minutes during the second hour of magnesium sulfate therapy. Assess P, R, and BP a minimum of once an hour during maintenance therapy.

The nurse notices that the hemoglobin levels of an infant who is breastfed have reduced drastically since birth. What is the probable reason for the infant to have anemia? A. The infant's mother is still taking folic acid and B vitamins. B. The infant's mother is consuming large amounts of caffeine. C. The infant's mother continues to take oral iron supplements. D. The infant's mother drinks large amounts of water and juices.

B - Caffeine intake leads to reduced absorption of iron into the milk. In turn this reduces the concentration of iron in the milk, which may cause anemia in the newborn. Iron supplements are usually prescribed to prevent anemia in the mother. Iron does not cause anemia in the newborn. Folate supplements help prevent spina bifida (SB) in the newborn. Folate does not cause anemia in the newborn. Excess fluids help maintain the blood volume in the mother and enhance the formation of milk. Excess fluids do not cause anemia in the newborn.

What is the antidote for magnesium sulfate? A. Nifedipine B. Calcium gluconate C. Propanolol D. Ferrous gluconate

B - Calcium gluconate 1g IV over 3 minutes. This should be available in the room if magnesium sulfate is infusing.

Which drug will the health care provider prescribe to soften the cervix of a woman who is at 42 weeks of gestation? A. Methylergonovine (Methergine) B. Dinoprostone (Prepidil) C. Betamethasone (Celestone) D. Terbutaline (Brethine)

B - Dinoprostone is a natural chemical in the body that causes uterine and gastrointestinal smooth muscle stimulation. It plays a role in cervical softening and dilation unrelated to uterine muscle stimulation. It is used to start and continue cervical ripening at term. Methergine is used to treat postpartum bleeding. Betamethasone is used to enhance fetal lung development. Terbutaline is used to treat premature labor.

A pregnant woman was hospitalized and catheterized with a Foley catheter. She developed a urinary tract infection caused by Pseudomonas aeruginosa and was treated with gentamicin. Which of the following adverse effects was a risk to the fetus when the woman was on gentamicin? (protein synthesis inhibitors) A. Skeletal deformity. B. Hearing loss. C. Teratogenesis. D. Blindness. E. Mental retardation.

B - Gentamicin can cross the placental barrier and cause hearing loss in the newborns of mothers who have received it. The other adverse effects are not risks with gentamicin.

A pregnant patient asks the nurse if she can double her prenatal vitamin dose because she does not like to eat vegetables. What is the nurse's response regarding the danger of taking excessive vitamins? A. Increases caloric intake B. Has toxic effects on the fetus C. Increases absorption of all vitamins D. Promotes development of pregnancy-induced hypertension (PIH)

B - Has toxic effects on the fetusThe use of vitamin supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some vitamins have been linked to fetal defects. Vitamin supplements do not contain calories. Vitamin supplements do not have better absorption than natural vitamins and minerals. There is no relationship between vitamin supplements and PIH.

To prevent gastrointestinal (GI) upset, when should a pregnant client be instructed to take the recommended iron supplements? A. On a full stomach B. At bedtime C. After eating a meal D. With milk

B - Iron supplements taken at bedtime may reduce GI upset and should be taken at bedtime if abdominal discomfort occurs when iron supplements are taken between meals. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption.

The nurse is preparing a diet chart for a Hispanic pregnant patient who is a vegetarian. The patient complains of leg cramps. What does the nurse ensure to include in the patient's diet? A. Melon fruit B. Turnip greens C. Whole or 2% milk D. Canned sardines

B - Leg cramps during pregnancy result from an imbalance in the calcium levels in the body. Thus the nurse would include a food rich in calcium in the diet. Because the patient is a vegetarian, this can be accomplished by incorporating turnip greens in the diet. Turnip greens are turnip leaves that are rich in calcium. Even though sardines have high calcium content, the patient is a vegetarian and this is considered a meat source. Milk is the richest source of calcium. Hispanic people do not consume milk directly but use it as an additive in coffee. Having too much coffee also affects the pregnant patient's health adversely, so it should not be included. Melon fruit is rich in vitamin A but is not a good source of calcium; therefore the nurse should not suggest it to increase calcium in the patient's diet.

Which of the following drugs is absolutely contraindicated in pregnancy? A. Atenolol B. Losartan C. Methyldopa D. Nifedipine E. Propranolol

B - Losartan Methyldopa is often recommended in pregnant patients because it has a good safety record.Calcium channel blockers (choice D) and beta blockers (A and E) are not contraindicated.In contrast ACE inhibitors and ARBs (choice B) are known to be teratogenic.

Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy? A. promethazine B. ondansetron C. methotrexate D. oxytocin

B - Methotrexate, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. Oxytocin is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. Promethazine and ondansetron are antiemetics that may be used to treat hyperemesis gravidarum.

A pregnant patient experienced preterm labor at 30 weeks' gestation. Upon assessing the patient, the nurse finds that the newborn is at risk of having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in the newborn? A. Calcium gluconate to the pregnant patient B. Magnesium sulfate to the pregnant patient C. Glucocorticoid drugs to the pregnant patient D. Antibiotic medications to the pregnant patient

B - Newborns who are born before 32 weeks' gestation may be at risk of cerebral palsy. Administering magnesium sulfate to the patient can prevent this risk as it would delay delivery. Calcium gluconate is administered when the preterm child has magnesium toxicity. This intervention would not help to prevent cerebral palsy. Also, the newborn would not have a fully developed respiratory system. Therefore administering glucocorticoids to the pregnant patient would help to prevent the risk of respiratory depression in the baby. However, it does not help in preventing cerebral palsy. Administering antibiotics during labor would help prevent neonatal group B streptococci infection.

The nurse is caring for a pregnant patient who is receiving terbutaline (Brethine) treatment. The primary health care provider (PHP) adds nifedipine (Adalat) to the patient's prescription. How does the nurse administer nifedipine (Adalat) to the patient? A. Infuse nifedipine (Adalat) along with terbutaline (Brethine). B. Infuse nifedipine (Adalat) only after terbutaline (Brethine) is stopped. C. Provide a glass full of orange juice before administering nifedipine (Adalat). D. Provide the patient with calcium supplements before administering nifedipine (Adalat).

B - Nifedipine (Adalat) is a calcium channel blocker that is used to relax the uterine muscles during pregnancy. Therefore the nurse should avoid administering nifedipine (Adalat) along with terbutaline (Brethine), because it causes adverse effects and may alter the heart rate and blood pressure of the patient. Infusing nifedipine (Adalat) along with terbutaline (Brethine) may impair cardiovascular functioning in the patient. Therefore the nurse should avoid infusing the drugs simultaneously. Orange juice is administered to relax the patient during labor. However, it is not necessary to administer it with nifedipine (Adalat). Nifedipine (Adalat) is administered to reduce the calcium activity; no additional calcium supplementation is required.

A pregnant patient arrives for her first prenatal visit at the clinic. She informs the nurse that she has been taking an additional 400 mcg of folic acid prior to becoming pregnant. Based on the patient's history, she has reached 8 weeks' gestation. Which recommendation would the nurse provide regarding folic acid supplementation? A. Have the patient continue to take 400 mcg folic acid throughout her pregnancy. B. Tell the patient that she no longer has to take additional folic acid because it will be included in her prenatal vitamins. C. Have the patient increase her folic acid intake to 1000 mcg throughout the rest of her pregnancy. D. Schedule the patient to go for an AFP (alpha-fetoprotein) test.

B - Tell the patient that she no longer has to take additional folic acid because it will be included in her prenatal vitamins.Prenatal vitamins include adequate folic acid supplementation, so patients should not take additional supplementation as long as they continue their prenatal vitamins. During pregnancy, the recommendation is to increase the folic acid intake to 600 mcg. 1000 mcg of folic acid would be an excessive dose. The AFP test should be done at 15 to 18 weeks' gestation. This is not clinically indicated because the patient is at 8 weeks' gestation.

The nurse administers the prescribed nifedipine (Adalat) to a pregnant patient during labor to reduce uterine contractions (UCs). Which nursing action is the most appropriate after the drug administration? Monitoring the: A. Heart rate of the fetus B. Blood pressure of the patient C. Respiration rate of the patient D. Blood sugar levels in the patient

B - The nurse should monitor the blood pressure of the patient after administering nifedipine (Adalat). It is a calcium channel blocker that compresses the smooth muscle contractions, resulting in hypotension. Nifedipine (Adalat) does not alter fetal heart rate or respiration rate and blood sugar levels of the patient. Heart rate of the fetus is monitored when other classes of tocolytics are administered. Respiration rate is monitored when oxytocin (Pitocin) is administered to the patient. Blood sugar levels are monitored in patients with diabetes who are receiving glucocorticoid therapy.

A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for continuation of the tocolytic effect? A. Buccal oxytocin (Pitocin) B. Terbutaline sulfate (Brethine) C. Calcium gluconate (Calgonate) D. Magnesium sulfate (Magnesium sulfate)

B - The woman receiving decreasing doses of magnesium sulfate often is switched to oral terbutaline to maintain tocolysis. Buccal oxytocin increases the strength of contractions and is used to augment or stimulate labor. Buccal oxytocin dosing is uncontrollable. Calcium gluconate reverses magnesium sulfate toxicity. The drug should be available for complications of magnesium sulfate therapy. Magnesium sulfate usually is given intravenously or intramuscularly. The patient must be hospitalized for magnesium therapy because of the serious side effects of this drug.Test-Taking Tip: Monitor questions that you answer with an educated guess or changed your answer from the first option you selected. This will help you to analyze your ability to think critically. Usually your first answer is correct and should not be changed without reason.

The nurse is caring for a pregnant patient who is administered magnesium sulfate to prevent preterm labor. Which parameters should the nurse assess in the patient to determine drug toxicity? Select all that apply. A. Fluid intake B. Respiratory status C. Body temperature D. Level of consciousness E. Deep tendon reflexes

B, D, E - Magnesium sulfate, when used as a tocolytic agent, depresses the central nervous system (CNS). The CNS depressive effect would be enhanced if the drug reaches toxic levels. CNS activity can be determined by assessing the respiratory status, level of consciousness, and deep tendon reflexes. A low respiratory rate, decreased level of consciousness, and slow reflexes indicate magnesium sulfate toxicity. Fluid intake and body temperature are not affected by CNS depression.

If your client with preeclampsia has been receiving magnesium sulfate for many hours prior to delivery, what complications would she and her infant be at risk for? (choose all that apply) A. Scant lochia flow postpartum B. A boggy uterus with heavy lochia flow postpartum C. Postpartum hemorrhage D. Increased duration of labor E. Neonatal respiratory depression and drowsiness

B. A boggy uterus with heavy lochia flow postpartum C. Postpartum hemorrhage D. Increased duration of labor E. Neonatal respiratory depression and drowsiness

The nurse has administered a dose of betamethasone by deep IM injection to a multipara at 30 weeks' gestation who is in preterm labor. What is the nurse's next action regarding injection site care? A. Gently massage the injection site. B. Apply gentle pressure to the injection site. C. Vigorously massage the injection site. D. Apply firm pressure to the injection site.

B. Apply gentle pressure to the injection site.

A patient at 26 weeks' gestation received a course of betamethasone 7 days ago. This patient will have a cesarean delivery because of preeclampsia with severe features. What effects should the antenatal corticosteroid therapy have on the newborn? A. Decreased risk of neonatal intraventricular hemorrhage, RDS, and cerebral palsy B. Decreased risk of neonatal intraventricular hemorrhage, RDS, and necrotizing enterocolitis C. Decreased risk of neonatal intraventricular hemorrhage, RDS, and neonatal infection D. Decreased risk of RDS, necrotizing enterocolitis, and neonatal infection B

B. Decreased risk of neonatal intraventricular hemorrhage, RDS, and necrotizing enterocolitis

The nurse is teaching a patient taking prenatal vitamins how to avoid constipation. Which should the nurse plan to include in the teaching session? (Select all that apply.) A. Advise taking a daily laxative for constipation. B. Recommend a diet high in fruits and vegetables. C. Encourage an increase in fluid consumption during the day. D. Increase the intake of whole grains and whole grain products. E. Suggest increasing the intake of dairy products, especially cheeses.

B. Recommend a diet high in fruits and vegetables. C. Encourage an increase in fluid consumption during the day. D. Increase the intake of whole grains and whole grain products. Common sources of dietary fiber include fruits and vegetables (with skins when possible—apples, strawberries, pears, carrots, corn, potatoes with skins, and broccoli), whole grains, and whole grain products—whole wheat bread, bran muffins, bran cereals, oatmeal, brown rice, and whole wheat pasta. Increased intake of fluids can help prevent constipation. A pregnant patient should not take a daily laxative unless prescribed by her health care provider. Increased intake of dairy products, especially cheese, may increase constipation.

Folic acid needs to be converted to its active form to be used in the body to do what? What is usually the substance that makes this conversion happen?

B12 converts folic acid to folate. Folate is used in synthesis of DNA and cell division

The nurse is teaching a patient with anemia when and how to take the prescribed iron supplements. The nurse provides a list of beverages for the patient to stay away from while taking the iron supplement. What is the rationale for this? A. They can affect the process of hematopoiesis. B. They increase red blood cell (RBC) destruction. C. They can decrease iron supplement absorption. D. They can increase the plasma levels of caffeine.

C - Anemia is caused by decreased hemoglobin levels in the blood, which, in turn, is caused by decreased iron intake. Iron supplements are usually given to treat iron deficiency anemia. Tea, coffee, and milk decrease iron absorption, which reduces the efficiency of iron supplements. Therefore the nurse teaches the anemic patient to stop drinking tea, coffee, and milk with the iron supplement. Tea, coffee, and milk do not affect the plasma levels of caffeine, the hematopoiesis process, or cause RBC destruction.

Which drug will the nurse administer to prevent neonatal conjunctivitis in the newborn? A. Silver nitrate B. Dexamethasone C. Erythromycin D. Vitamin K

C - Erythromycin is the drug of choice because they prevent neonatal conjunctivitis from Neisseria gonorrhoeae and chlamydial ophthalmia neonatorum from Chlamydia trachomatis. Silver nitrate is an outdated treatment for neonatal ocular infections. Dexamethasone is given for lung development. Vitamin K is given for treatment of hemorrhage.

Which minerals and vitamins are usually recommended as a supplement in a pregnant client's diet? A. Fat-soluble vitamins A and D B. Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc

C - Iron should generally be supplemented, and folic acid supplements are often needed because folate is so important in pregnancy. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C is sometimes naturally consumed in excess; vitamin B6 is prescribed only if the woman has a very poor diet; and zinc is sometimes supplemented. Most women get enough calcium.

What will the nurse include when teaching a postpartum patient about expected adverse effects of Rho(D) immune globulin? (Select all that apply.) a. Nausea b. Constipation c. Fever d. Insomnia e. Aches f. Diarrhea g. Anorexia

C, E - Fever as well as generalized aches and pains are common adverse effects of treatment with this drug. Nausea, constipation, insomnia, diarrhea, and anorexia are not adverse effects of Rho(D) immune globulin.

A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature 37.3° C, pulse rate 88 beats/min, respiratory rate 10 breaths/min, blood pressure (BP) 152/98 mm Hg, absent deep tendon reflexes, and no ankle clonus with a urine output of 25 ml/hr for the past 2 hours . The client complains, "I'm so thirsty and warm." The nurse initially would: A. Call for a stat magnesium sulfate level B. Administer oxygen C. Discontinue the magnesium sulfate infusion D. Prepare to administer hydralazine

C. Discontinue the magnesium sulfate infusion

A patient at 35 weeks' gestation presents to the labor unit reporting rupture of the membranes and contractions every 5 to 8 minutes. Electronic fetal monitoring displays a Category I (normal) FHR pattern and contractions every 5 minutes. The patient rates the contraction pain as 6 on a scale of 0 to 10. A vaginal examination reveals that the cervix is 2 cm dilated and 60% effaced and the fetal presenting part is at -1 station. The patient's temperature is elevated and the amniotic fluid has a foul odor. Why would corticosteroid administration not be appropriate for this patient? A. Delivery of the newborn is imminent. B. The recommended gestational age range for antenatal corticosteroids is 24 to 32 weeks. C. The patient may have chorioamnionitis. D. The patient has gestational hypertension.

C. The patient may have chorioamnionitis.

Your client on Magnesium sulfate therapy is experiencing the following symptoms, drowsiness, respiratory rate of 8, unable to respond to LOC check, and DTR's absent. Your initial nursing action is to: A. notify the healthcare provider. B. obtain magnesium blood level. C. turn off the magnesium infusion. D. administer calcium gluconate to reverse the magnesium infusion.

C. turn off the magnesium infusion.

Ampicillin

Class: antiinvective (B) Used to treat GBS. May be associated with false positive Coomb's test and cleft palate.

A patient at 28 weeks' gestation is admitted for 23-hour observation. The patient is pregnant with twins and reports irregular contractions that are increasing in frequency. The practitioner has ordered betamethasone 6 mg IM every 12 hours. What should be the first nursing intervention? A. Assess the patient for diabetes and assess fetal status before administering betamethasone. B. Assume the practitioner intended to order dexamethasone because the ordered dosage is appropriate for dexamethasone. C. Administer the betamethasone as soon as possible so it will take effect before the patient delivers. D. Clarify the practitioner's order because the usual dosage for betamethasone is 12 mg every 24 hours for a total of two doses.

D. Clarify the practitioner's order because the usual dosage for betamethasone is 12 mg every 24 hours for a total of two doses.

A pregnant patient with significant iron-deficiency anemia is prescribed iron supplements. The patient explains to the nurse that she cannot take iron because it makes her nauseous. What is the best response by the nurse? A. "Iron will be absorbed more readily if taken with orange juice." B. "It is important to take this drug regardless of this side effect." C. "Taking the drug with milk may decrease your symptoms." D. "Try taking the iron at bedtime on an empty stomach."

D - "Try taking the iron at bedtime on an empty stomach."Iron taken at bedtime may be easier to tolerate. All the answers are true statements; however, only the option that states that iron taken at bedtime may be easier to tolerate addresses both optimal absorption of iron and alleviation of nausea, which will not be noticeable during sleep. It is true that taking iron with milk will decrease the symptoms; however, it will also decrease absorption.

The nurse is providing dietary education to a patient who is 4 months pregnant. Which diet should the nurse suggest to the patient for proper neural development of the fetus? A. Nuts, beans and legumes, cocoa, meats, and whole grains B. Iodized salt, milk and milk products, yeast breads, and rolls C. Citrus fruits, broccoli, melons, strawberries, and tomatoes D. Asparagus, eggs, fortified cereals, and green leafy vegetables

D - A diet rich in vitamin B12 and folic acid is essential for proper neural development of the fetus during pregnancy. Asparagus, fortified cereals, and green leafy vegetables are rich sources of folic acid, and eggs are rich in vitamin B12. Therefore a diet containing these foods is most advisable for the patient to ensure proper neural development of the fetus. Nuts, beans and legumes, cocoa, meats, and whole grains are rich sources of magnesium. Iodized salt, milk and milk products, yeast breads, and rolls contain iodine. Citrus fruits, broccoli, melons, strawberries, and tomatoes are rich sources of vitamin C. Magnesium, iodine, and vitamin C do not affect the neural development of the fetus.

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant. Which guidance should she expect to receive? A. "Discontinue all contraception now." B. "Lose weight so that you can gain more during pregnancy." C. "You may take any medications you have been regularly taking." D. "Make sure you include adequate folic acid in your diet."

D - A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. A woman's folate or folic acid intake is of particular concern in the preconception period. Neural tube defects are more common in infants of women with a poor folic acid intake. Depending on the type of contraception that she has been using, discontinuing all contraception at this time may not be appropriate. Advising this client to lose weight now so that she can gain more during pregnancy is also not appropriate advice. Depending on the type of medications the woman is taking, continuing to take them regularly may not be appropriate.

A pregnant patient has been administered terbutaline (Brethine) as prescribed. The nurse finds that the patient has a heart rate of 140 beats/min and complains of chest pain. What is the best nursing action in this situation? A. Administer propranolol (Inderal). B. Administer intravenous fluids. C. Administer 1 g calcium gluconate. D. Inform the primary health care provider (PHP).

D - A heart rate of 140 beats/min and chest pain indicates that the patient is having tachycardia, which is an adverse effect of terbutaline (Brethine). Therefore the nurse should report this to the PHP to obtain further instructions on the treatment. Propranolol (Inderal) is administered to reverse the cardiovascular adverse effects of terbutaline (Brethine). However, it needs to be prescribed by the PHP. Calcium gluconate is administered to reverse the effect of magnesium sulfate. Serum potassium should be monitored in the patient receiving terbutaline therapy; however, it is not a priority intervention. The patient has tachycardia and is not in a state of hypovolemic shock. Therefore intravenous fluids need not be administered to the patient.

The nurse is instructed to administer 12 mg of betamethasone (Celestone) to a pregnant patient at 30 weeks' gestation. Which nursing intervention should be performed for the safe administration of the drug? A.Give the medication by oral route. B. Assess platelet levels after drug administration. C. Administer increased doses of insulin with the drug. D. Follow a strict time interval of 24 hours between two doses

D - Betamethasone (Celestone) is an antenatal glucocorticoid that is given intramuscularly (IM) to pregnant women between 24 and 34 weeks' gestation. It is administered to prevent morbidity and mortality associated with preterm labor due to respiratory distress syndrome. Therefore the nurse should administer the drug in two doses with a time interval of 24 hours because optimal fetal benefits start 24 hours after the first injection. The drug cannot be administered orally because it may impair the absorption of the drug; therefore the drug must be given only through the IM injection route. Increased doses of insulin are administered only if the patient has a history of well-controlled blood sugar levels. The drug causes increased blood glucose levels and increased white blood cells (WBCs) but not blood platelet levels. Therefore it is not useful to assess the blood platelet levels in the patient after the drug is administered.

When should iron supplementation during a normal pregnancy begin? A. Before pregnancy B. In the first trimester C. In the third trimester D. In the second trimester

D - In the second trimesterVitamin supplements should be prescribed in the second trimester, when the need for iron is increased. Healthy young women do not usually need iron supplementation for their diets. Morning sickness in the first trimester increases the routine side effects of iron supplements. The iron supplements may continue to be prescribed in the third trimester and during the postpartum period.

In order to increase the absorption of iron by a pregnant patient, which beverage should an iron preparation be given with? A. Tea B. Milk C. Coffee. D. Orange juice

D - Orange juiceVitamin C source may increase the absorption of iron and would be the optimal choice. Tannin in the tea reduces the absorption of iron. The calcium and phosphorus in milk decrease iron absorption. Decreased intake of caffeine is recommended during pregnancy.

The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity? A. lung sounds B. oxygen saturation C. magnesium sulfate level D. reflexes

D - Reflex assessment is part of the standard assessment for clients on magnesium sulfate. The first change when developing magnesium toxicity may be a decrease in reflex activity. The health care provider needs to be notified immediately. A change in lung sounds and oxygen saturation are not indicative of magnesium sulfate toxicity. Hourly blood draws to gain information on the magnesium sulfate level are not indicated.

A pregnant woman's diet may not meet her increased need for folates. Which food is a rich source of this nutrient? A. Chicken B. Cheese C. Potatoes D. Green leafy vegetables

D - Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken and cheese are excellent sources of protein but are poor sources for folates. Potatoes contain carbohydrates and vitamins and minerals but are poor sources for folates.

The nurse is reviewing a list of foods high in folic acid with a patient who is considering becoming pregnant. The nurse determines that the patient understands the teaching when the patient states she will include which list of foods in her diet? A. Peaches, yogurt, and tofu B. Strawberries, milk, and tuna C. Asparagus, lemonade, and chicken breast D. Spinach, orange juice, and fortified bran flakes

D - Spinach, orange juice, and fortified bran flakesPrepregnant, the recommendation for folic acid is 800 mcg. Foods high in folic acid are dark green leafy vegetables, legumes (beans, peanuts), orange juice, asparagus, spinach, and fortified cereal and pasta. In the United States, folic acid is added to orange juice and wheat-based products.

A client states that she does not drink milk. Which foods should the nurse encourage this woman to consume in greater amounts to increase her calcium intake? A. Fresh apricots B. Canned clams C. Spaghetti with meat sauce D. Canned sardines

D- Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are not high in calcium.

Prior to administration of intravenous (IV) hydralazine (Apresoline), the nurse would evaluate for which symptom? A. A decrease in pulse pressure. B. Pulse rate in excess of 110. C. Presence of confusion and disorientation. D. A significant decrease in blood pressure.

D. A significant decrease in blood pressure.

A patient is a gravida 1, Rh-negative woman at a 28 weeks gestation. The father of her child is Rh positive. The mother is asking the nurse about the effect on her unborn child of RhoGAM that has been ordered. What is the nurses best reply? A. Your child will do well after birth once transfusions are administered. B. If the baby is Rh negative at birth, he or she will need RhoGAM also. C. RhoGAM kills antibodies you make, so your child will be protected. D. Your baby may be Rh positive and cause you to make antibodies. These wont affect this baby, but could affect future children if RhoGAM isnt given.

D. Your baby may be Rh positive and cause you to make antibodies. These wont affect this baby, but could affect future children if RhoGAM isnt given.

What are some teaching items you would provide to a patient who is about to start Fe supplementation?

Dark green or black stool possible, not a sign of bleeding. Liquid preps can stain teeth--take through a straw and swallow water as a chaser. Doses should be spaced evenly throughout the day

What is iron used for in the body?

Iron is the center of a four part macromolecule, hemoglobin, that is used to transport O2 and CO2

When are iron requirements increased in the body? When does most of our Fe leave the body?

Iron requirements are increased when there is RBC loss and hematopoeisis is needed, and when a woman is pregnant. Iron stores need replenishing when we are bleeding/menses/donating blood, or during pregnancy or rapid growth

What is the duration of magnesium sulfate therapy for a Preeclampsia patient?

The infusion will be maintained during labor, delivery and recovery up to 24 hours postpartum, or as ordered by the physician.

What are foods that are rich in iron?

Red meat, pork, poultry, seafood, green leafy vegetables, raisins and dried apricots, and iron-fortified grains

What class of drug is terbutaline?

Sympathomimetic bronchodialator, tocolytic (B)

What is folic acid?

Synthetic folate, a B vitamin. For a deeper dive into folic acid and B12 see https://quizlet.com/129823314/pharm-week-9-iron-b12-folic-acid-questions-flash-cards/

methotrexate sodium

Used to treat unruptured ectopic pregnancy. Women on methotrexate therapy should not drink alcohol and should discontinue folic acid supplements as they increase the reis of rupture. Dissolves residual tissue post operatively

Is the average diet sufficient for the body's iron needs? When is supplementation needed?

Vegetarians tend to not get enough iron through their diet, and supplementation is needed for them. Those who eat meat do tend to eat enough iron. Other good sources of iron are raisins, and avoiding eating iron chelating agents such as tea

Folic acid recommendations:

Woman of childbearing age should take 400 mcg of folic acid daily, pregnant or not. The greatest need for folic acid is in the first few weeks of pregnancy, before many women even know they are pregnant.