Frandsen Chapter 6 - Test Bank

16. A pregnant woman states that she has been constipated since becoming pregnant. Which medication is most appropriate for preventing constipation related to pregnancy? A. Psyllium B. Mineral oil C. Saline cathartic D. Stimulant cathartic

ANS: A Rationale: A bulk-producing agent, such as psyllium, is most physiologic for the mother and safe for the fetus. Mineral oil is not recommended because it interferes with absorption of fat-soluble vitamins. Saline cathartics are not recommended because of hypernatremia. Stimulant cathartics are not recommended for the pregnant woman.

1. A pregnant woman is experiencing nausea and vomiting in her first trimester of pregnancy. Which herbal agent that has traditionally been used as an antiemetic could the nurse discuss with the client? A. Ginger B. Garlic C. Ginkgo biloba D. Green tea

ANS: A Rationale: Ginger has been used to relieve nausea and vomiting during pregnancy. Garlic, Ginkgo biloba, and green tea are not recommended to relieve nausea and vomiting in pregnancy.

19. A woman was administered misoprostol in an effort to induce labor, but the health care team is unsatisfied with the results. Consequently, oxytocin will be used. Prior to administering oxytocin, what must occur? A. Four hours must elapse after the last dose of misoprostol. B. The woman must have a type and cross-match performed. C. The woman must receive a bolus of 500-mL normal saline. D. The woman must have her electrolytes measured.

ANS: A Rationale: If the course of treatment changes and oxytocin is to be given after misoprostol, it is essential to wait 4 hours from the last administration of misoprostol before starting oxytocin. Blood work and IV hydration are not necessary.

10. An 18-week-gestation pregnant woman has been diagnosed with fetal demise. What medication can be administered to initiate the birthing process? A. Misoprostol B. Calcium gluconate C. Magnesium sulfate D. Folic acid

ANS: A Rationale: Misoprostol is administered to initiate the birthing process in the client with fetal demise prior to 20 weeks' gestation. Calcium gluconate is administered for hypermagnesemia. Magnesium sulfate is administered for preterm labor and toxemia. Folic acid is administered to prevent fetal neural tube defects.

20. A couple have been trying unsuccessfully for nearly a year to become pregnant and have now sought fertility counseling. The nurse should be aware of what potential etiological factors related to infertility? Select all that apply. A. Absence of sperm B. Endometriosis C. Vaginitis D. Blocked fallopian tubes E. Fibromyalgia

ANS: A, B, D Rationale: In women, the most common causes are ovulation disorders, blocked fallopian tubes, endometriosis, and advanced maternal age, which affects egg quality and quantity. In men, causes include absence of sperm, declining sperm counts, testicular abnormalities, and ejaculatory dysfunction. Vaginitis cannot cause infertility, and fibromyalgia is not noted as a common etiological factor.

2. A pregnant woman asks why she needs to take a folic acid supplement. What is the nurse's best explanation for the administration of folic acid? A. "Folic acid prevents the development of contractions." B. "Folic acid prevents neural tube birth defects." C. "Folic acid builds strong fetal bones." D. "Folic acid will decrease nausea and vomiting."

ANS: B Rationale: Folic acid prevents neural tube birth defects. Folic acid does not prevent contractions. Folic acid will not build fetal bones. Folic acid will not prevent nausea and vomiting.

9. A client is receiving oxytocin. Which is a maternal-focused adverse effect of the medication? A. Acute confusion B. Hypertension C. Edema D. Inverted T wave

ANS: B Rationale: Hypertension is a maternal adverse effect of oxytocin. This adverse reaction is a result of the medication's ability to constrict involuntary muscles like those lining blood vessels. Other adverse effects include cardiac dysrhythmias, nausea, vomiting, excessive uterine stimulation, and water intoxication. Confusion, edema, and inverted T wave are not adverse effects of oxytocin since none are a result of involuntary muscle contraction.

14. When administering magnesium sulfate, the nurse should assess the client for what sign? A. Dry, pale skin B. Respiratory depression C. Agitation D. Tachycardia

ANS: B Rationale: Overdoses of magnesium sulfate may lead to hypotension, muscle paralysis, respiratory depression, and cardiac arrest. The nurse would not anticipate dry, pale skin; agitation; or tachycardia.

4. A woman in preterm labor is being treated with magnesium sulfate intravenously. Which of the assessment should be implemented during the administration of magnesium sulfate? A. Assess uterine bleeding. B. Assess magnesium level. C. Assess potassium level. D. Assess for fever.

ANS: B Rationale: When administering magnesium sulfate, it is important to assess the serum magnesium level. The client in preterm labor should not experience uterine bleeding related to magnesium sulfate administration. The client will not need her serum potassium level monitored. The client will not need to be assessed for fever related to magnesium sulfate administration.

7. A woman who is 7 months pregnant is experiencing gastroesophageal reflux. Which medication is most highly recommended? A. Terbutaline B. Diphenoxylate C. Ranitidine D. Chlorothiazide

ANS: C Rationale: A histamine2 receptor antagonist, such as ranitidine, is used for gastroesophageal reflux disease. Terbutaline is a tocolytic agent. Diphenoxylate is not administered for GERD. Chlorothiazide is a diuretic agent.

17. A woman prescribed the highly active antiretroviral therapy (HAART) for HIV/AIDS has become pregnant. What is the effect the woman's pregnancy is expected to have on her drug regimen? A. She must discontinue HAART due to risk of teratogenic effects. B. Her dosages of HAART must be increased to reduce the risk of in utero transmission. C. She can continue her HAART unchanged as long as recommended doses are prescribed. D. Some components of her HAART must be replaced or discontinued.

ANS: C Rationale: Antiretroviral drug therapy for the pregnant woman reduces perinatal transmission by about two thirds. In general, highly active antiretroviral therapy, or HAART, is safe, with recommended dosage the same as for nonpregnant women. None of the remaining options accurately describe the effect pregnancy will have on this medication therapy.

22. A nurse is performing health education with a woman who has just learned that she is pregnant. The nurse has explained the concept of teratogenic drugs and emphasized the need to have her health care provider assess any medications she should consider taking. The nurse should teach the woman that drug-induced teratogenicity is most likely to occur at what point in her pregnancy? A. During the second half of her third trimester B. In the 7 to 10 days after conception C. In the first trimester during organogenesis D. During 30 to 34 weeks of gestation.

ANS: C Rationale: Drug-induced teratogenicity is most likely to occur when drugs are taken during the first 3 months of pregnancy, during organogenesis.

21. A woman has been unable to conceive for many months and will soon begin treatment with clomiphene. What health education should the nurse provide to this client? A. Avoid drinking alcohol while taking clomiphene. B. Perform daily OTC pregnancy tests beginning the day after taking clomiphene. C. Take basal temperature between 5 and 10 days after taking clomiphene. D. Report any numbness or tingling in the hands or lips to the health care provider.

ANS: C Rationale: Ovulation occurs 5 to 10 days after the course of clomiphene treatment has been completed. Prior to beginning the drug regimen, the nurse instructs the woman about taking her basal temperature 5 to 10 days following administration. An incremental rise in temperature is an indication of ovulation. There is no specific contraindication against alcohol, and neurologic adverse effects are not expected.

12. A woman is being administered IV magnesium sulfate. What is a desired outcome related to the administration of magnesium sulfate? A. Increased contractions B. Respiratory rate above 18 C. Decreased blood pressure D. Increased uterine tone

ANS: C Rationale: The administration of magnesium sulfate can prevent seizure activity and reduce severe hypertension. Magnesium sulfate is administered for preterm labor to prevent contractions and reduce uterine tone, not to increase respiratory rate.

3. A woman is being administered IV magnesium sulfate for treatment of toxemia. What is the most important outcome related to the administration of magnesium sulfate? A. Decreased contractions B. Respiratory rate below 16 C. Absence of seizure activity D. Diminished reflexes

ANS: C Rationale: The administration of magnesium sulfate to treat toxemia can prevent seizure activity. Magnesium sulfate is administered for preterm labor to prevent contractions, not for toxemia. A respiratory rate below 16 and diminished reflexes are indicative of excess magnesium sulfate.

8. An infant is born to an HIV/AIDS-positive mother. What treatment is provided for the infant? A. Zidovudine for 2 weeks after delivery B. Zidovudine for 4 weeks after delivery C. Zidovudine for 6 weeks after delivery D. Zidovudine for 2 months after delivery

ANS: C Rationale: The infant born to an HIV-positive mother should be administered zidovudine for 6 weeks after delivery. The infant born to an HIV-positive mother will not be administered zidovudine for 2 weeks, 4 weeks, or 2 months.

13. A woman who began labor several hours ago is now prescribed oxytocin. What is the goal of oxytocin therapy? A. Prevent postpartum bleeding. B. Decrease fetal hyperactivity. C. Augment weak or irregular contractions. D. Diminish periods of uterine relaxation.

ANS: C Rationale: Use of this manufactured hormone induces labor or augments weak or irregular uterine contractions during labor. It is not used in the labor phase to prevent bleeding. It is not administered to decrease fetal hyperactivity. The administration of oxytocin should allow for adequate periods of relaxation between contractions.

23. A primiparous woman was vigilant in avoiding medications and herbs during her pregnancy and states that she is similarly committed to protecting her baby's health now that she is breast-feeding. What principle should guide the woman's use of medications while breast-feeding? A. Very few herbs are explicitly contraindicated while breast-feeding. B. It is generally safe to use herbs rather than medications while breast-feeding. C. Most women can resume their prepregnancy herbal medication regimen after birth. D. Not all herbs are safe while a woman is breast-feeding.

ANS: D Rationale: A wide variety of medications and herbs are contraindicated during pregnancy and lactation. To be safe, the breast-feeding mother should consult with her primary health care provider before self-medicating with herbs. None of the remaining options accurately describe the safe use of herbs while breast-feeding.

6. A woman in preterm labor has developed depressed deep tendon reflexes. Which medication will be administered? A. Potassium chloride B. Epinephrine C. Carboprost D. Calcium gluconate

ANS: D Rationale: Calcium gluconate is administered for hypermagnesemia. Potassium chloride, epinephrine, and carboprost will not be administered for hypermagnesemia.

18. A woman is at 42 weeks of gestation. Which medication will be administered to promote cervical ripening? A. Calcium gluconate B. Magnesium sulfate C. Terbutaline D. Dinoprostone

ANS: D Rationale: Dinoprostone is administered to ripen the cervix in a woman who is at 42 weeks of gestation. Calcium gluconate, magnesium sulfate, and terbutaline are not administered to ripen the cervix. Calcium gluconate is prescribed to reverse hypermagnesemia. Magnesium sulfate is prescribed in the management of hypertension related to preeclampsia. Terbutaline is used to inhibit uterine contractions in cases such as premature labor.

5. A client is being administered magnesium sulfate for preterm labor. The client's serum magnesium level is 11 mg/dL. What signs and symptoms will the client present? A. Tachypnea B. Muscle rigidity C. Tachycardia D. Depressed deep tendon reflexes

ANS: D Rationale: Hypermagnesemia will cause depressed deep tendon reflexes. The serum magnesium level of 11 would result in depressed respirations. The serum magnesium level of 11 would result in decreased muscle strength. The serum level of 11 would result in bradycardia, not tachycardia.

11. A client is being treated at home for preterm labor. Which beta-adrenergic medication is administered orally to decrease uterine contractions? A. Magnesium sulfate B. Oxytocin C. Nifedipine D. Terbutaline

ANS: D Rationale: Terbutaline is a beta-adrenergic agent that inhibits uterine contractions by reducing intracellular calcium levels. Magnesium sulfate is administered intravenously and not administered at home. Oxytocin induces labor. Nifedipine is a calcium channel blocker that decreases uterine contractions.

15. A woman in preterm labor has been administered terbutaline sulfate. For what potential adverse effects should the nurse assess? A. Pruritus (itching) and copious diaphoresis B. Joint pain and numbness in the extremities C. Headache and visual disturbances D. Palpitations and shortness of breath

ANS: D Rationale: Terbutaline sulfate is a beta-adrenergic agent that inhibits uterine contractions by reducing intracellular calcium levels. Adverse effects may include hyperkalemia, hyperglycemia, cardiac dysrhythmias, hypotension, and pulmonary edema. Women commonly experience hand tremors, palpitations, and shortness of breath with chest tightness.