Women's Health/ Newborn Drugs

Vitamin K 0.5 mg is prescribed for a newborn. The vial on hand is labeled "1 mL = 2 mg." How many milliliters should the nurse administer? Include a leading zero if applicable and record your answer using two decimal places. _____ mL

0.25 mL

A client is admitted to the high-risk unit in preterm labor. A loading dose of 6 g of magnesium sulfate over 20 minutes is prescribed, to be followed by 2 g/hr. Premixed stock is available with 40 g of magnesium sulfate in 1000 mL of D5W. At a rate of how many milliliters should a nurse set the infusion pump to complete the loading dose? Record your answer using a whole number. _____ mL/hr

450mL/hr

After breast cancer is diagnosed, the client decides on a modified radical mastectomy followed by a combination therapy protocol that includes doxorubicin. What assessment finding does the nurse recognize as a toxic effect of this drug? 1 Paralytic ileus 2 Red-tinged urine 3 Cardiac dysrhythmias 4 Increased serum magnesium

3 Cardiac dysrhythmias Doxorubicin has the potential for cardiac toxicity. Paralytic ileus is a toxic effect of vincristine, not doxorubicin. Red urine is a benign side effect, the result of metabolism of the doxorubicin. The magnesium level is not influenced by doxorubicin.

A woman reports weight gain and hot flashes. The client is also found to have low estrogen levels. Which drug may be prescribed to alleviate hot flashes? 1 Estradiol 2 Raloxifene 3 Clomiphene 4 Dinoprostone

1 Estradiol Estradiol is a form of estrogen that helps to alleviate hot flashes by increasing estrogen levels. Raloxifene may cause or increase hot flashes. Clomiphene may cause conception in infertile women and is not advised. Dinoprostone may cause a termination of pregnancy.

A woman with type 2 diabetes mellitus continues taking oral tolbutamide during her pregnancy. What type of malformation may the newborn develop? 1 Hypoglycemia 2 Congenital defects 3 Neural tube defects 4 Cleft lip with cleft palate

1 Hypoglycemia Hypoglycemia may be seen in the newborn if the mother takes oral hypoglycemic agents during pregnancy. Diethylstilbestrol may cause congenital defects in the newborn. Valproic acid may cause neural tube defects. Nitrofurantoin and topiramate may cause cleft lips with cleft palates.

A breastfeeding mother requires treatment for depression. Which drug would be safe to use if the mother wishes to continue breastfeeding the newborn? 1 Fluoxetine 2 Paroxetine 3 Valproic acid 4 Methotrexate

2 Paroxetine Paroxetine can be safely given during breastfeeding. Fluoxetine can easily enter breast milk; therefore this drug would only be used when other selective serotonin reuptake inhibitors are ineffective. Valproic acid is an antiepileptic drug that can be given safely to breastfeeding women. Methotrexate is an anticancer drug that cannot be given during breastfeeding because it enters the breast milk and can cause adverse effects in the baby.

Which physiologic characteristics of newborns affect drug dosage considerations? Select all that apply. 1 A newborn's less regulated body temperature 2 Immature liver and kidneys 3 Thick and less permeable skin 4 Lungs with weaker mucous barriers 5 Bacteria-killing acid in the stomach

1 A newborn's less regulated body temperature 2 Immature liver and kidneys 4 Lungs with weaker mucous barriers The body temperature of newborns is less regulated and dehydration occurs easily. This characteristic affects the drug dose consideration in newborns. Metabolism and excretion are impaired in pediatric clients due to an immature liver and kidneys. The lungs in pediatric clients have weak mucous barriers; this characteristic also affects the drug dosage considerations in newborns. A newborn's skin is thin and more permeable. The newborn has no acid in the stomach to kill the bacteria; therefore, drug absorption from the gastrointestinal tract is affected, thus impacting drug dosage considerations.

Which teratogen causes masculinization of the female fetus? 1 Danazol 2 Vitamin A 3 Topiramate 4 Tetracycline

1 Danazol Danazol is an androgen that may cause masculinization of the female fetus as a teratogenic effect. Vitamin A may cause fetal cardiac defects. Topiramate may cause fetal growth delays. Tetracycline may cause tooth and bone abnormalities as teratogenic effects.

A nurse is caring for an obese client in early labor. The anesthesiologist discusses several types of analgesia and anesthesia with the client and recommends one. The client requests clarification before signing the consent form. Which type has the anesthesiologist recommended? 1 Epidural anesthesia 2 Oral opioid analgesia 3 Pudendal nerve anesthesia 4 Intravenous opioid analgesia

1 Epidural anesthesia Epidural anesthesia during the first stage of labor decreases metabolic and respiratory demands and is preferred for obese clients. Obese women are sensitive to systemic opioids, which predispose them to respiratory depression; oral medications do not have a uniform rate of absorption and are not recommended during labor. A pudendal block does not reach the uterus, so contractions are felt; it is used during the second stage of labor.

A nurse instructs a client who is taking oral contraceptives to increase her intake of dietary supplements. Which supplement should be increased? 1 Calcium 2 Vitamin C 3 Vitamin E 4 Potassium

2 Vitamin C Oral contraceptives can affect the metabolism of certain vitamins, particularly vitamin C, and supplementation may be required. It is unnecessary to increase the intake of calcium when one is taking oral contraceptives. There is no clinical evidence linking oral contraceptives with a deficiency of vitamin E. There is no interrelationship between oral contraceptives and dietary intake of potassium.

A woman reports irregular menses and weight gain. Upon diagnosis, the woman has low hormone levels and is treated with infertility drugs to conceive. Which nursing interventions would be beneficial to this client? Select all that apply. 1 Monitor vital signs. 2 Encourage the client to track her medications in a journal. 3 Recommend the self-administration of oral drugs. 4 Recommend the long-term use of indomethacin orally. 5 Administer oral drugs to the client when the client wakes up along with six glasses of water.

1 Monitor vital signs. 2 Encourage the client to track her medications in a journal. 3 Recommend the self-administration of oral drugs. The nurse should monitor the client's vital signs to minimize the risk of hypotension. Journal tracking of medication helps to ensure the regular administration of the drug. Self-administration of oral drugs at home should be encouraged, and proper instructions regarding the administration should be provided to ensure rational use of the drug. The nurse should not advise the long-term oral use of indomethacin because it may cause birth defects. The administration of oral drugs upon rising with six glasses of water is the nursing intervention for administration of oral bisphosphonates in the treatment of osteoporosis.

A pregnant client who is Rh negative visits the prenatal clinic during the first trimester of pregnancy. She is informed by the primary healthcare provider that Rh sensitization is suspected and that Rho(D) immune globulin eventually will be given. At what week of gestation should the nurse explain that the medication will be administered? 1 12 weeks 2 28 weeks 3 36 weeks 4 40 weeks

2 28 weeks Rho(D) immune globulin (RhoGAM) administered during the twenty-eighth week of gestation reduces an active antibody response in an Rh-negative individual exposed to Rh-positive blood. It is difficult to determine whether Rh sensitization has occurred this early in pregnancy. RhoGAM is given earlier in the pregnancy; it is a preventive measure, not a treatment for a woman who is already sensitized. Forty weeks is around the time of birth; if the client has not been sensitized, she will receive RhoGAM within 72 hours of birth.

A postmenopausal woman has been administered raloxifene for osteoporosis. Which parameter should be assessed to ensure the efficacy of the drug and thus its continuation of use? 1 Body weight 2 Bone density 3 Calcium levels in urine 4 Esophageal functioning

2 Bone density An increase in bone density indicates a good therapeutic response to raloxifene. Thus this parameter should be assessed during therapy for osteoporosis. Body weight may or may not increase with bone weight, and this parameter should not be used to assess a positive response to the drug. Calcium levels in the blood indicate response to the therapy rather than calcium levels in urine. Esophageal dysfunction is a contraindication to bisphosphonate therapy.

Which effect is seen when the fetus is exposed to a teratogen during the embryonic period? 1 Delay in growth 2 Gross malformations 3 Death of the conceptus 4 Disruption of brain development

2 Gross malformations Gross malformations occur if there is exposure to a teratogen during the embryonic period or the first trimester. During the fetal period, exposure to a teratogen causes delays in growth and development of the fetus. Death of the conceptus occurs if exposed to a lethal dose of teratogen during the preimplantation period. Exposure to a teratogen during the fetal period (second or third trimester) causes disruption of brain development.

A client who has a diagnosis of endometriosis is concerned about the side effect of hot flashes from her prescribed medications. Which medication should the nurse explain causes this side effect? 1 Estrogen 2 Leuprolide 3 Diclofenac 4 Ergonovine

2 Leuprolide Leuprolide decreases the levels of luteinizing hormone and follicle-stimulating hormone, as well as hormone-dependent tissue. One of its side effects is hot flashes. Estrogen affects the release of pituitary gonadotropins and inhibits ovulation; it is contraindicated because the goal of treatment is to suppress the action of estrogen on the endometrial tissue. Diclofenac is used for primary dysmenorrhea; it is a nonsteroidal antiinflammatory drug that inhibits prostaglandin synthesis. Ergonovine is used to induce contraction of the postpartum uterus.

Which drug is safe to administer to a lactating woman but may cause teratogenic effects when administered to pregnant clients? 1 Tetracycline 2 Methotrexate 3 Carbamazepine 4 Cyclophosphamide

3 Carbamazepine Carbamazepine is safe to administer in a lactating woman but may cause neural tube defects as a teratogenic effect. Tetracycline may cause tooth and bone abnormalities as a teratogenic effect. Methotrexate may cause limb malformations as a teratogenic effect. Cyclophosphamide may cause secondary cancer as a teratogenic effect. Tetracycline, methotrexate, and cyclophosphamide should not be administered to breast-feeding women.

An alcoholic mother gave birth to a baby who had alcohol dependency. Which nursing intervention would be helpful in managing alcohol dependency in the baby? 1 Avoid alcohol in the treatment 2 Give treatment to reduce alcohol abuse 3 Give reduced doses of alcohol to overcome drug dependency 4 Administer alcohol to the baby to prevent withdrawal symptoms

3 Give reduced doses of alcohol to overcome drug dependency The baby born to an alcoholic mother should be treated with reduced doses of alcohol to wean the baby from the alcohol dependency. Avoiding alcohol may cause withdrawal syndrome, and the baby may show symptoms of shrill crying and extreme irritability. Treatment to counter the alcohol abuse in the baby may not be effective. Alcohol should not be provided in normal doses to reduce the alcohol dependency or to prevent withdrawal symptoms.

A baby was born with skull hypoplasia. Which condition might the nurse find in the treatment history of the mother? 1 Thyroid 2 Epilepsy 3 Hypertension 4 Microbial infection

3 Hypertension A newborn may have skull hypoplasia if the mother is exposed to angiotensin-converting enzyme inhibitors for the treatment of hypertension during her pregnancy. Thyroid treatments may cause goiter in a newborn as a teratogenic effect. Epilepsy treatments may cause neural tube defects in newborns. Treatments for microbial infections may cause the absence of eyes as a teratogenic effect.

A lactating woman takes fluoxetine to treat depression. Her newborn developed tremors, seizures, and fever. Which drug-induced physiologic alterations may be responsible for the central nervous system effects of the drug on the neonate? 1 Increase in fat content 2 Increase in protein binding 3 Immature blood-brain barrier 4 Delayed first stooling

3 Immature blood-brain barrier Many drugs are able to enter the neonate's brain due to the immature blood-brain barrier causing central nervous system effects. Neonates have a low fat content. Protein binding is decreased in neonates because the liver is immature and produces fewer proteins. First pass elimination is decreased in neonates due to the liver's immaturity.

An ultrasound scan of a 23-week fetus reveals a cleft palate. Which nursing intervention is most appropriate? 1 Abort the pregnancy 2 Suggest that the client use oral medication 3 Instruct the parents that surgery can be done later in childhood to correct the palate 4 Determine the time and duration of exposure to the teratogen

3 Instruct the parents that surgery can be done later in childhood to correct the palate A cleft palate is a minor congenital anomaly that may occur as a result of exposure to a teratogen. The nurse should suggest that the parents consider surgery after the child's birth. An abortion is not required because a cleft palate is not a major congenital anomaly. The use of oral medications will not affect the deformity. The determination of the time and duration of exposure to a teratogen would be helpful before organogenesis but not after the deformity is seen.

What is an important nursing intervention when a client is receiving intravenous (IV) magnesium sulfate for preeclampsia? 1 Limiting IV fluid intake 2 Preparing for a possible precipitous birth 3 Maintaining a quiet, darkened environment 4 Obtaining magnesium gluconate as an antagonist

3 Maintaining a quiet, darkened environment A quiet, darkened room reduces stimuli, which is essential for limiting or preventing seizures. IV infusions are not limited. Infusions are monitored closely and usually maintained at a volume of 125 mL/hr. Precipitous birth is not a usual side effect of magnesium therapy. Calcium gluconate, not magnesium gluconate, is the antagonist for magnesium sulfate and should be kept on hand in case signs of toxicity appear.

Which drug impairs fertility when administered along with fertility drugs? 1 Clomiphene 2 Menotropins 3 Promethazine 4 Choriogonadotropin alfa

3 Promethazine When taken with fertility drugs, promethazine increases prolactin concentration, which may impair fertility. Clomiphene and menotropins are ovulation stimulants given to induce ovulation in infertile women. Choriogonadotropin alfa is a recombinant form of human gonadotropin hormone; this drug is an ovulation stimulant.

A client at 32 weeks' gestation is admitted to the birthing unit because she is having regular labor contractions. A prescription for 6 mg of intramuscular dexamethasone, twice a day for 2 days, is issued. The client asks why she needs this medicine. The nurse explains that this corticosteroid is prescribed because it does what? 1 Promotes sleep 2 May stop contractions 3 Relaxes uterine muscles 4 Accelerates fetal lung maturity

4 Accelerates fetal lung maturity Dexamethasone is a glucocorticoid that aids fetal production of surfactant, which is needed for postnatal lung expansion; it is not until 35 weeks' gestation that there is enough surfactant to confirm fetal lung maturity by way of amniocentesis. Glucocorticoids are not sedatives. Tocolytics, not glucocorticoids, may stop contractions. Tocolytics, not glucocorticoids, relax the uterine muscles.

A pregnant woman was diagnosed with hypertension and was administered magnesium sulfate. What drug should be co-administered to prevent magnesium toxicity? 1 Nifedipine 2 Terbutaline 3 Indomethacine 4 Calcium gluconate

4 Calcium gluconate Calcium gluconate reverses magnesium toxicity and can be administered to pregnant women taking magnesium sulfate. Nifedipine is a calcium channel blocker used as a tocolytic for the management of preterm labor. Terbutaline is a beta-adrenergic blocker used to manage preterm labor. Indomethacine is a nonsteroidal antiinflammatory drug used as a tocolytic for the management of preterm labor.

Which drug is used to counteract drug toxicity caused by magnesium sulfate in preterm labor management? 1 Nifedipine 2 Indomethacin 3 Dexamethasone 4 Calcium gluconate

4 Calcium gluconate Magnesium sulfate is used to treat pregnancy-induced hypertension. Calcium gluconate should be readily available to counter the drug toxicity caused by magnesium sulfate. Nifedipine is used to treat preterm labor by inhibiting myometrial activity by blocking the calcium reflex. Indomethacin is a nonsteroidal antiinflammatory drug used to treat preterm labor. Dexamethasone is given when delivery is proceeding to improve lung maturity in the fetus.

Which drug taken by a pregnant woman shows a delayed teratogenic effect in the offspring, making the effect difficult to identify? 1 Aspirin 2 Heparin 3 Ethyl alcohol 4 Diethylstilbestrol

4 Diethylstilbestrol Diethylstilbestrol may cause vaginal cancer in a female child 18 or more years after birth. Aspirin suppresses contractions during labor and may cause bleeding in the mother. Heparin does not cause fetal harm but may cause osteoporosis in the mother. Ethyl alcohol causes drug dependence or alcohol withdrawal syndrome in neonates.

A pregnant woman reports severe headaches, chest pain, and fatigue. Upon diagnosis, the woman has hypertension. Which drug can be prescribed to reduce hypertension? 1 Lithium 2 Miglitol 3 Calcium gluconate 4 Magnesium sulfate

4 Magnesium sulfate Magnesium sulfate can be prescribed for pregnancy-induced hypertension. Lithium is used to treat body water retention. Miglitol is used to decrease blood sugar levels. Calcium gluconate is used to relieve magnesium toxicity associated with magnesium sulfate.

What intrauterine medication exposure may lead to the child being born with a cleft lip? 1 The mother was on phenytoin therapy. 2 The mother was on multivitamin therapy. 3 The mother was taking methotrexate. 4 The mother was on nitrofurantoin therapy.

4 The mother was on nitrofurantoin therapy. Nitrofurantoin should not be administered during pregnancy because this drug may cause abnormally small or absent eyes, heart defects, or a cleft lip with a cleft palate. Phenytoin, multivitamins, and methotrexate do not cause a cleft lip.

A nursing student analyzes drug information on a chart. Which statement by the nursing student indicates a need for further teaching? 1 Oxytocin shows a delayed onset of action. 2 Methylergonovine shows an immediate peak plasma concentration. 3 The elimination half-life of uterine stimulants is independent of peak plasma concentration. 4 The temporal relation between the onset of action and elimination half-life of uterine stimulants is proportional.

4 The temporal relation between the onset of action and elimination half-life of uterine stimulants is proportional. The time taken for the elimination half-life of methylergonovine and oxytocin is proportional to the onset of action. Elimination half-life of a drug is the plasma concentration when 50 percent of a drug is eliminated. Oxytocin shows a rapid onset of action as it is applied topically. Methylergonovine does not show immediate peak plasma concentration because drugs taken orally require time for absorption. The elimination half-life of uterine stimulants is dependent of peak plasma concentration.

A nurse is caring for a client who is being given intravenous magnesium sulfate to treat preeclampsia. Which effect alerts the nurse to notify the primary healthcare provider? 1 Respiratory rate of 18 breaths/min 2 2+ patellar reflex response 3 Blood pressure of 112/76 mm Hg 4 Urine output of less than 100 mL in 4 hours

4 Urine output of less than 100 mL in 4 hours A decreased urine output of less than 25 mL/hr may be indicative of kidney damage, a result of the preeclampsia, and impending renal failure. Magnesium sulfate is excreted by the kidneys, and magnesium toxicity may occur. Respirations at this rate are within the expected range; a rate of at least 16 breaths/min should be present before each dose of magnesium sulfate. Loss of the patellar reflex is suggestive of magnesium sulfate toxicity; a 2+ reflex is within the expected range. A blood pressure of 112/76 mm Hg is within normal limits.