OB Pharm
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 Answer: 1 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. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
A woman in the first trimester of pregnancy wants to terminate her pregnancy due to malformations in her fetus. Which oxytocic drug should be administered to the client?
1 Oxytocin 2 Misoprostol 3 Mifepristone 4 Dinoprostone Answer: 3 Mifepristone is a progesterone antagonist used to induce the voluntary termination of a pregnancy. Oxytocin is generally used to induce and enhance labor. Misoprostol and dinoprostone are given during the second trimester to induce an abortion.
A client consumes alcohol during pregnancy. Which condition does the nurse anticipate to be seen in the newborn? 1 Stillbirth 2 Heart defects 3 Growth delay 4 Multiple defects
Answer: 1 A client who is an alcohol abuser may deliver a stillborn baby. Heart defects occur in the newborn when the mother is exposed to antimicrobials during her pregnancy. Newborn growth delays may be caused by antiseizure drug exposure in the mother. Multiple defects may be seen in a child whose mother was exposed to vitamin A derivatives.
Which drug may cause tooth and bone anomalies as a teratogenic effect?
1 Alcohol 2 Estrogen 3 Tetracycline 4 Valproic acid Answer: 3 Tetracycline causes tooth and bone anomalies in fetuses when it is given to the mother during pregnancy. Alcohol causes fetal alcohol syndrome. Estrogen causes congenital defects of the female reproductive organs. Valproic acid causes neural tube defects.
A woman who underwent infertility treatment is pregnant with twins. Which drug might have been responsible?
1 Raloxifene 2 Methylergonovine 3 Clomiphene 4 Dinoprostone Answer: 3 Clomiphene is used as a part of infertility treatment to promote ovulation. However, this drug can lead to multiple pregnancies. Raloxifene is prescribed to prevent postmenopausal osteoporosis. Methylergonovine is prescribed to reduce postpartum uterine hemorrhage. Dinoprostone is prescribed for the termination of a pregnancy.
A baby was born with a single-lobed brain and also had neural tube defects. Which drug treatment in the client during her gestation might have caused this condition?
1 Simvastatin 2 Isotretinoin 3 Carbamazepine 4 Cyclophosphamide Answer: 1 Neural tube defects and single-lobed brains are teratogenic effects in a newborn associated with simvastatin, an HMG-CoA reductase inhibitor. Isotretinoin may cause central nervous system (CNS) defects. Carbama
Which drug may be used to treat postpartum hemorrhage? 1 Dinoprostone 2 Clomiphene 3 Menotropins 4 Methylergonovine
Answer: 4 Methylergonovine is a drug of choice used to treat postpartum hemorrhage. Clomiphene and menotropins are ovulation stimulants given to induce ovulation in infertile women. Dinoprostone is used to induce cervical ripening and cause termination of a pregnancy.
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 Answer: 4 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.
Shortly after birth the nurse instills erythromycin ophthalmic ointment in the newborn's eyes. The father asks why an antibiotic is needed. The nurse explains that it is routinely administered to prevent what type of infection?
1 Gonorrhea 2 Toxoplasmosis 3 Rubella 4 Cytomegalovirus Answer: 1 The antibiotic ointment is administered prophylactically to prevent the development of ophthalmia neonatorum, which may be contracted during a vaginal birth to a mother with gonorrhea, chlamydia, or both infections. Cytomegalovirus, toxoplasmosis, and rubella are contracted by the fetus in utero during various stages of pregnancy, not during birth. Erythromycin ophthalmic ointment would be ineffective treatment for these conditions.
A new mother is diagnosed with depression. Which antidepressant may be prescribed to this client?
1 Sertraline 2 Fluoxetine 3 Amphetamine 4 Carbamazepine Answer: 1 Sertraline is considered safe in lactating females. Dosing immediately after breast-feeding can reduce the risk of the drug excreted in the breast milk by the next feeding time. Fluoxetine and amphetamine are not recommended for breast-feeding clients. Carbamazepine is not used to treat depression.
A client who is visiting the family planning clinic is prescribed an oral contraceptive. As part of teaching, the nurse plans to inform the client of the possibility of which adverse effect? 1 Cervicitis 2 Ovarian cysts 3 Fibrocystic breasts 4 Breakthrough bleeding
Answer: 4 Breakthrough bleeding, or midcycle bleeding, commonly occurs when women start using oral contraceptives. If it persists, the dosage should be changed. There is no evidence that cervicitis, ovarian cysts, or fibrocystic breasts are related to the use of oral contraceptives. Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question.
A client who underwent treatment for infertility gave birth to triplets. She often complained of breast pain during the infertility treatment. Which drug may have been administered to the client for infertility treatment?
1 Estradiol 2 Haloperidol 3 Clomiphene 4 Promethazine Answer: 3 Clomiphene is an ovarian stimulant that may cause multiple pregnancies. Breast pain is an adverse effect of clomiphene. Estradiol helps to reduce postmenopausal hot flashes. Haloperidol and promethazine are contraindicated while using clomiphene.
A nurse is reviewing a postmenopausal client's history, which reveals that the client previously received hormonal therapy (HT) as treatment for osteoporosis. The nurse recognizes that HT increases the risk of which condition?
1 Breast cancer 2 Rapid weight loss 3 Accelerated bone loss 4 Vaginal tissue atrophy Answer: 1 There is a relationship between HT that combines estrogen and progesterone compounds and an increased incidence of invasive breast cancer. One side effect of HT is weight gain with ankle and foot edema. Bone loss is slowed with HT. Vaginal tissue maintains turgor and lubrication with HT.
A pregnant client is treated with sertraline for depression. What can be inferred about the drug's action?
1 It will only affect the client. 2 It will only affect the fetus. 3 It will affect both the client and the fetus. 4 It will not have any effect on both client and the fetus. Answer: 3 Drugs taken during pregnancy may act on both the client and the fetus as the drug passes through the placenta from the mother to the fetus. The drug action would be meant for treatment in the client and it may affect the fetus in anyway. The drug does not show effects only on the fetus.
Which hormone levels do not need to be monitored during the administration of menotropins for infertility?
1 Estrogen 2 Luteinizing hormone 3 Follicle-stimulating hormone 4 Gonadotropin-releasing hormone Answer: 4 Menotropins that are administered for infertility act at the pituitary level. Gonadotropin-releasing hormones act at the hypothalamic level; therefore, this hormone does not need to be monitored. Menotropin is a standardized mixture of follicle-stimulating hormone and luteinizing hormone; these hormones should be monitored. Also, estrogen levels need to be monitored because the luteinizing hormone indirectly stimulates the production of estrogen.
A pregnant woman is administered medication to treat preterm labor that requires a prescription for calcium gluconate to counter the effects of the drug. Which drug was administered?
1 Nifedipine 2 Indomethacin 3 Betamethasone 4 Magnesium sulfate Answer: 4 Magnesium sulfate is used to prevent preterm labor in pregnant women with hypertension. To reduce magnesium toxicity caused, calcium gluconate should also be prescribed to counter the effects of this drug. Nifedipine is a calcium channel blocker that inhibits myometrial activity by blocking the calcium influx. Indomethacin is a nonsteroidal antiinflammatory agent used along with sucralfate to protect the stomach. Betamethasone is a corticosteroid used when preterm labor is not maintained by other treatments and delivery is proceeding.
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 Answer: 4 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.
A baby was born with shortened limbs. Which drug treatment may have been given to the mother during her gestation? 1 Phenytoin 2 Topiramate 3 Thalidomide 4 Carbamazepine
Answer: 3 Thalidomide is an anticancer drug that may cause shortening of the limbs as a teratogenic effect. Phenytoin, topiramate, and carbamazepine are anti-seizure drugs that may cause growth delays and neural tube defects.
The nurse is explaining insulin needs to a client with gestational diabetes who is in her second trimester of pregnancy. Which information should the nurse give to this client? 1 Insulin needs will increase during the second trimester. 2 Insulin needs will decrease during the second trimester. 3 Insulin needs will not change during the second trimester. 4 Insulin will be switched to an oral antidiabetic medication during the second trimester.
Answer: 1 The second trimester of pregnancy exerts a diabetogenic effect on the maternal metabolic status. Major hormonal changes result in decreased tolerance of glucose, increased insulin resistance, decreased hepatic glycogen stores, and increased hepatic production of glucose. Increasing levels of human chorionic somatomammotropin, estrogen, progesterone, prolactin, cortisol, and insulinase increase insulin resistance through their actions as insulin antagonists. Insulin resistance is a glucose-sparing mechanism that ensures an abundant supply of glucose for the fetus. Maternal insulin requirements gradually increase from about 18 to 24 weeks of gestation to about 36 weeks' gestation. The use of oral antidiabetes agents is currently not recommended by the American Diabetes Association for use during pregnancy.
A client with hypertension has labor pains before the 35th week of gestation. Which pharmacologic intervention does the nurse anticipate to be beneficial for this client?
1 Preparing the client for an abortion 2 Administer terbutaline 3 Administer magnesium sulfate 4 Administer sedatives and maintain hydration Answer: 3 Magnesium sulfate is the drug of choice for maintaining pregnancy in preterm labor in hypertensive clients. An abortion is advisable if the preterm labor starts before the 20th week of gestation because the fetus may be nonviable. Terbutaline is used to maintain pregnancy in preterm labor by relaxing the uterine smooth muscle. The use of sedatives and body hydration measure are nonpharmacologic interventions to maintain pregnancy in preterm labor.
Which drug has an effect opposite to that of misoprostol?
1 Nifedipine 2 Mifepristone 3 Indomethacin 4 Dinoprostone Answer: 3 Misoprostol is a prostaglandin derivative that is used to induce uterine contractions and promote abortion. Indomethacin is used to maintain a pregnancy in preterm labor by inhibiting prostaglandin activity, which is the converse of misoprostol's effects. Nifedipine is a calcium channel blocker used to maintain a pregnancy in preterm labor. Mifepristone is a progesterone antagonist used along with misoprostol to induce abortion. Dinoprostone is a prostaglandin derivative used to dilate the opening of the cervix.
A pregnant woman at risk of preterm labor is diagnosed with hypertension. Which drug should be administered?
1 Terbutaline 2 Indomethacin 3 Calcium gluconate 4 Magnesium sulfate Answer: 4 Magnesium sulfate is administered to treat pregnancy-induced hypertension. Terbutaline is used to treat preterm labor, but does not reduce hypertension. Indomethacin inhibits prostaglandin activity and seizes uterine contractions. Calcium gluconate is given to reduce magnesium toxicity. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.
A female client with Hodgkin disease is to start chemotherapy. She and her husband have been trying to have a child and are concerned when they learn that sterility may result. On what information should the nurse base the reply? 1 Ova can be harvested and frozen for future use. 2 Chemotherapy is not radical enough to destroy ovarian function. 3 Ovarian function will be temporarily destroyed but will return in time. 4 Radiation can be substituted for chemotherapy to preserve ovarian function
Answer: 1 Women in their childbearing years who have cancer should be informed of all options available to preserve their ability to reproduce. Chemotherapy can depress or destroy ovarian function. Destroyed ovarian function cannot be reversed; it is permanent. Both radiation and chemotherapy can destroy ovarian function.
A woman receiving treatment with topiramate gives birth to a newborn with a cleft lip and cleft palate. Which Food Drug Administration (FDA) Pregnancy Risk category of pregnancy does the drug belong?
1 B 2 C 3 D 4 X Answer: 3 (Category D) According to the FDA Pregnancy Risk Category system, category D contains drugs that pose a risk to the fetus, but the benefits of drug use during pregnancy are acceptable despite the risks. Category B contains drugs that may cause fetal harm, but there is no evidence of a definite risk. Category C contains drugs that may cause fetal harm. Category X contains drugs that show definite risk of fetal abnormalities; for these drugs, the risks outweigh the benefits of the drugs. Test-Taking Tip: Multiple-choice questions can be challenging because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.
A pregnant client with iron-deficiency anemia is prescribed iron supplements daily. To help the client increase iron absorption, the nurse should suggest that the client eat foods high in which substance? 1 Vitamin C 2 Fat content 3 Water content 4 Vitamin B complex
Answer: 1 Vitamin C aids the absorption of iron. Fat content, water content, and vitamin B complex are all unrelated to the absorption of iron. STUDY TIP: Rest is essential to the body and brain for good performance; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the rested mind's efficiency will balance out the difference in the time spent studying. Knowing your natural body rhythms is necessary when it comes to determining the amount of sleep needed for personal learning efficiency.
A nurse discusses the type of anesthesia that will be used for a vaginal birth with a client who has class I cardiac disease. Which type of block is most appropriate for this client? 1 Spinal 2 Epidural 3 Pudendal 4 Inhalation
Answer: 2 Epidural analgesia is used for a client with class I cardiac disease because the client will be comfortable and have minimal stress when forceps or vacuum extraction is used to shorten the second stage of labor. Spinal anesthesia is rarely used for a birth. The anesthetic is injected into the subarachnoid space. Although a pudendal block is adequate, epidural analgesia is more effective because less energy is expended during labor and it provides more effective pain relief. Inhalation anesthesia is not indicated for a vaginal birth for a client with class I cardiac disease; it may cause respiratory difficulty.
Which drug is responsible for neonatal hypoglycemia? 1 Warfarin 2 Simvastatin 3 Tolbutamide 4 Methimazole
Answer: 3 Tolbutamide is an oral hypoglycemic agent used in the treatment of type 2 diabetes mellitus. It is known to have teratogenic effects like neonatal hypoglycemia. Warfarin, a common blood thinner, may cause teratogenic effects such as skeletal and central nervous system defects. Simvastatin, an HMG-CoA reductase inhibitor used for the treatment of high cholesterol, may cause teratogenic effects like facial malformations and severe central nervous system anomalies. Methimazole, an antithyroid drug administered for the treatment of maternal hyperthyroidism, may cause teratogenic effects like neonatal goiter, cretinism, and hypothyroidism.
Which drug aids in uterine evacuation in cases of miscarriage? 1 Oxytocin 2 Misoprostol 3 Dinopristone 4 Methylergonovine
Answer: 3 Dinopristone is a prostaglandin E2 abortifacient that causes uterine evacuation in cases of miscarriage. Oxytocin induces labor by enhancing uterine contractions and promotes milk ejection during lactation. Misoprostol is a stomach protectant that helps in cervical ripening. Methylergonovine is an oxytocic ergot alkaloid used to treat postpartum uterine atony and hemorrhage.
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
Answer: 4 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.
A client in active labor becomes very uncomfortable and asks a nurse for pain medication. Nalbuphine is prescribed. How does this medication relieve pain? 1 By producing amnesia 2 By acting as a preliminary anesthetic 3 By inducing sleep until the time of birth 4 By acting on opioid receptors to reduce pain
Answer: 4 Nalbuphine is classified as an opioid analgesic and is effective in relieving pain; it induces little or no newborn respiratory depression. Nalbuphine does not induce amnesia, act as an anesthetic, or induce sleep
A pregnant woman reports night sweats, sleep disturbances, and weight gain. Upon diagnosis, the woman has low levels of estrogen and is treated with hormonal therapy. Which teratogenic effect is likely to occur in the newborn? 1 Goiter 2 Neural tube defects 3 Cleft lip with cleft palate 4 Congenital defects of the female reproductive system
Answer: 4 Estrogen may cause congenital defects of the female reproductive system in the fetus. Antithyroid drugs may cause a goiter. Carbamazepine may cause neural tube defects. Nitrofurantoin may cause cleft lip with cleft palate
A newborn is Rh positive, and the mother is Rh negative. The infant is to receive an exchange transfusion. When the parents ask why their baby will receive Rh-negative blood, what explanation does the nurse provide? 1 The choice of Rh-positive or Rh-negative blood is determined by blood availability. 2 It is neutral and will not react with the baby's blood. 3 The possibility of a transfusion reaction is eliminated. 4 The red blood cells will not be destroyed by maternal anti-Rh antibodies
Answer: 4 Giving Rh-positive cells will lead to further hemolysis; Rh-negative cells are not attacked by maternal antibodies in the infant's blood. Rh-negative blood is not neutral; it provides a temporary safeguard from further hemolysis. A reaction to other antigens in the crossmatched blood may occur. The choice of Rh-positive or Rh-negative blood is not determined by blood availability. STUDY TIP: Focus your study time on the common health problems that nurses most frequently encounter.
Which drug would place a client's offspring at risk for vaginal cancer?
1 Danazol 2 Estrogen 3 Valproic acid 4 Diethylstilbestrol Answer: 4 Diethylstilbestrol is a synthetic nonsteroidal estrogen used in the treatment of menopausal and postmenopausal disorders. When it is consumed during pregnancy, it may show the delayed teratogenic effect of vaginal cancer in female offspring by the age of 18. Danazol is an androgen that may cause masculinization of the female fetus. Estrogen causes congenital defects of the female reproductive organs. Valproic acid, a drug used to control seizures, may cause neural tube defects. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
A client at 32 weeks' gestation is admitted to the prenatal unit in preterm labor. An infusion of magnesium sulfate is started. What physiologic response indicates to the nurse that the magnesium sulfate is having a therapeutic effect?
1 Dilation of the cervix by 1 cm every hour 2 Tightening and pain in the perineal area 3 A decrease in blood pressure to 120/80 mm Hg 4 A decrease in frequency and duration of contractions Answer: 4 The purpose of administering magnesium sulfate is to stop preterm labor. It is a tocolytic agent that relaxes uterine smooth muscle. Labor is progressing if dilation of the cervix continues. Perineal discomfort is usually felt as the fetus moves down the birth canal and labor is progressing. A decrease in blood pressure to 120/80 mm Hg is not a therapeutic effect of magnesium sulfate for a woman in preterm labor.
A registered nurse teaches a nursing student about steps to take to minimize the hazardous effects of maternal drugs on infants during breast-feeding. Which statement of the nursing student indicates the need for additional teaching?
1 "Avoid drugs that have a long half-life in the mother." 2 "Administer sustained-release formulations to the mother." 3 "Use the lowest effective dosage for the shortest possible time." 4 "The mother should be dosed immediately after breast-feeding." Answer: 2 Sustained-release formulation may have long-term effects on the infant through breast milk. Therefore these drug formulations should be avoided in a mother who is breastfeeding. Drugs that have a long half-life should not be administered to a breast-feeding mother to reduce the toxic effect of the drug on the infant. The lowest effective dosage should be used for the shortest possible time in the mother to reduce the toxic effects to the infant. Drug dosing should be immediately given to the mother after breast-feeding to minimize the drug concentration in the milk at the next feeding. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.
A 63-year-old woman with the diagnosis of estrogen receptor-positive cancer of the breast undergoes lumpectomy and radiation therapy, and tamoxifen is prescribed. The client asks the nurse how long she will have to take the medication. How will the nurse respond?
1 "You'll have to take it for the rest of your life." 2 "You'll need to take it for 10 days, like an antibiotic." 3 "You'll need to take it for 5 years, after which it will be discontinued." 4 "You'll need to take it for several months, until the bone pain subsides." Answer: 3 Tamoxifen is an estrogen antagonist antineoplastic medication that has been found to be effective in 50% to 60% of women with estrogen receptor-positive cancer of the breast. After 5 years of administration there is an increased risk of complications, and the drug is discontinued. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not for the rest of the client's life; this duration will not produce positive effects for the client. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not just for 10 days. Tamoxifen may cause the adverse effect of bone pain, which indicates the drug's effectiveness. Medication is given to manage the pain and the drug is continued.
An infertile client is found to have a hormonal deficiency at the pituitary level. Which fertility drug may be prescribed to treat infertility? 1 Estrogens 2 Clomiphene 3 Menotropins 4 Choriogonadotropin alfa
Answer: 3 Hormonal deficiencies at the pituitary level include follicle-stimulating hormone and luteinizing hormone deficiencies. Therefore menotropins, a standardized mixture of these hormones, would be administered to the client. Estrogens alone are ineffective. Clomiphene would be used if a hormonal deficiency is due to the hypothalamus. Choriogonadotropin alfa is an analogue of luteinizing hormone; this drug may not fully treat the client.
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 Answer: 2 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. Test-Taking Tip: Multiple-choice questions can be challenging because students think that they will recognize the right answer when they see it or that the right answer will somehow stand out from the other choices. This is a dangerous misconception. The more carefully the question is constructed, the more each of the choices will seem like the correct response.
A client undergoing treatment for a medical condition gave birth to a baby with renal failure as a result of the teratogenic effect of the medications. Which medical condition is the client likely getting treated for?
1 Cancer 2 Epilepsy 3 Hypertension 4 Microbial infection Answer: 3 Angiotensin-converting enzyme inhibitors used for treating hypertension may cause renal failure as a teratogenic effect. Treatment of cancer may cause central nervous system malformations. Treatment of epilepsy may cause growth delay. Antimicrobials may cause heart defects.
A postpartum woman treated with methylergonovine complained of dizziness, has low blood pressure, and has passed out. Which initial nursing action would help this client?
1 Document the findings 2 Encourage excess increased fluid intake 3 Advise to stop taking methylergonovine 4 Notify the primary healthcare provider Answer: 4 Methylergonovine may cause a sudden drop in blood pressure. Notifying the primary healthcare provider should be the priority action of the nurse in this condition in order to get proper treatment at the right time. Documentation of findings is also important, but it is not the initial step of the nurse. Excess fluid intake is necessary in this client, but it is not an initial step of the nurse. A nurse cannot advise stopping medication prescribed by primary healthcare provider unless instructed.
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 Answer: 3 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.
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 Answer: 3 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.
What is the drug of choice for a client who wants to abort her pregnancy at three months of gestation?
1 Nifedipine 2 Terbutaline 3 Mifepristone 4 Methylergonovine Answer: 3 Mifepristone is a progesterone antagonist that stimulates uterine contractions; it is used to selectively terminate a pregnancy. Nifedipine is a calcium channel blocker that is used to maintain pregnancy in cases of preterm labor. Terbutaline is a drug used to inhibit labor and maintain pregnancy. Methylergonovine is used to reduce postpartum uterine hemorrhage; this drug is not used for abortion.
A client who received intravenous magnesium sulfate for preeclampsia gives birth. What clinical finding in the newborn indicates to the nurse that magnesium sulfate toxicity may have occurred?
1 Pallor 2 Tremor 3 Hypotonia 4 Tachycardia Answer: 3 Hypotonia occurs with magnesium sulfate toxicity because of skeletal and smooth muscle relaxation. Pallor, tremor, and tachycardia are not signs of magnesium sulfate toxicity. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur.
Which type of drugs readily crosses the placenta?
1 Polar drugs 2 Ionized drugs 3 Lipid-soluble drugs 4 Protein-bound drugs Answer: 3 Drugs that are lipid soluble penetrate the placenta in higher concentrations. Polar drugs are not transferred in higher concentrations through the placenta. Nonionized drugs are more likely to be transferred through the placenta than ionized drugs. Protein-bound drugs remain in the maternal plasma because the molecules are too large to cross the placenta.
A lactating woman who reports a loss of interest in daily activities, loss of appetite, and sleeplessness is diagnosed with depression. What would be the drug of choice for this client if she wishes to continue breast-feeding?
1 Sertraline 2 Fluoxetine 3 Sumatriptan 4 Bromocriptine Answer: 1 Sertraline is the drug of choice for lactating woman with depression because it does not cause any effects on breast-feeding infants. Fluoxetine should be taken with caution because it may cause adverse effects on the infant at high dosages. Sumatriptan is the drug of choice for lactating woman suffering from migraines because it does not adversely affect to the fetus. Bromocriptine is contraindicated in lactating woman.
A newborn's mother is being treated with clemastine while breast-feeding. Which physiologic factors alter the pharmacokinetic properties of this drug in the neonate? Select all that apply.
1 Decreased fat content 2 Increased protein binding 3 Immature blood-brain barrier 4 Increased first pass elimination 5 Decreased glomerular filtration rate Answer: 1, 3, 5 In neonates, the fat content is low due to a large amount of total body water. As a result, the drug readily enters the brain due to the neonate's immature blood-brain barrier. Neonates have immature kidneys; therefore, the glomerular filtration rate is decreased. Protein binding is decreased in neonates because the liver is immature and produces less protein. First stooling is delayed in neonates due to liver immaturity.
A lactating woman receives treatment for a medical condition and is taking a prescription medication that cannot be withheld. What type of drugs can the client take to minimize the risk to the neonate? Select all that apply.
1 Drugs that have sustained release 2 Drugs that are excluded from milk 3 Drugs consumed immediately after breastfeeding 4 Drugs that are the least likely to affect the neonate 5 Drugs with the lowest effective dose for longer period Answer: 2, 3, 4 Drugs that do not enter the breast milk are preferred because they are safe for neonates. Drugs should be taken immediately after breastfeeding so that the concentrations of the drug will be low or nonexistent in the next feeding. Drugs that are least likely to affect the infant are preferred. Breast-feeding should be avoided if sustained drugs are taken because they remain for a longer time in plasma. Drugs with the lowest effective doses for a shorter period of time should be taken because they remain in the blood for a shorter period of time.
A woman reports night sweats, sleep disturbances, and weight gain. Upon diagnosis, the woman has low levels of estrogen and is given hormonal therapy. Which nursing interventions would be beneficial to the client? Select all that apply.
1 Encourage physical activity 2 Recommend the long-term use of estradiol 3 Advise the client to take oral forms of estradiol with food 4 Provide the client with instructions on self-administration 5 Instruct the client to administer oral forms of estradiol at any time during the day Answer: 1, 3, 4 The nurse should encourage the client to perform physical activities to reduce her weight. Taking oral forms of estradiol with food helps to minimize gastrointestinal upset. The nurse should provide instructions on self-administration of the drug for safety purposes. The nurse should not recommend long-term use of estradiol because of the potential toxic effects. The client should take estradiol at the same time every day so that effective hormone serum levels are maintained.
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. Correct: 1, 2, 3 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. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.
Which interventions are included in the nursing care for a client receiving magnesium sulfate for severe preeclampsia? Select all that apply.
1 Monitoring deep tendon reflexes 2 Assessing urine output every 8 hours 3 Maintaining a dark, quiet environment 4 Using a pump to regulate the medication 5 Having calcium gluconate available at the bedside 6 Notifying the primary healthcare provider if the respiratory rate is slower than 20 breaths/min Answer: 1, 3, 4, 5 Magnesium sulfate level is monitored closely because toxicity may occur with levels over 8 mg/dL. It works by relaxing skeletal muscle; therefore deep tendon reflexes should be assessed hourly. Maintaining a dark, quiet environment decreases stimulation and reduces the risk of seizures. Magnesium sulfate must be administered with the use of an infusion pump because it can be toxic and cause respiratory distress. Calcium gluconate is the antidote to magnesium sulfate and should be immediately available for the treatment of overdose. Assessing urine output every 8 hours is not sufficient. Urine output of less than 30 mL/hr must be reported to the primary healthcare provider. A respiratory rate slower than 12 breaths/min, not 20, must be reported to the primary healthcare provider.
Which antimicrobial drugs are safe during breast-feeding? Select all that apply.
1 Penicillins 2 Macrolides 3 Tetracycline 4 Cephalosporins 5 Chloramphenicol Answer: 1, 2, 4 Penicillins, macrolides, and cephalosporins are considered safe drugs during breast-feeding as they are least likely to affect the infant. Tetracycline and chloramphenicol should be avoided during breast-feeding.
What antenatal precautions should be taken to minimize the risk of drug-induced teratogenesis? Select all that apply.
1 Preventing conception 2 Discontinuing teratogenic drugs during pregnancy 3 Avoiding the use of nonessential drugs during pregnancy 4 Terminating the pregnancy if the drug that causes teratogenicity cannot be withheld 5 Educating the client about the risks associated with teratogenic medication Answer: 3, 4, 5 Precautions should be taken while administering drugs during pregnancy to prevent teratogenesis. Nonessential drugs should be avoided. In conditions such as cancer where the treatment is highly toxic to the developing fetus but cannot be ethically withheld, terminating of pregnancy is recommended. Educating the client about risks associated with teratogenic medication is important because most pregnancies are unplanned. Preventing conception and discontinuing teratogenic drugs are not appropriate because the woman is already pregnant.
A tocolytic was administered to a woman to inhibit labor and maintain pregnancy. Which nursing interventions would be beneficial to this client? Select all that apply. 1 The drug should not be administered on a long term basis. 2 The drug should be continued after the contractions subside. 3 The client's vital signs and fetal heart rate should be monitored regularly. 4 The dose and route of administration should be determined. 5 The client should be placed in the right lateral recumbent position
Answer: 1, 3, 4 Long-term use of tocolytics may cause birth defects; therefore, tocolytics should not be administered on a long-term basis. The vital signs and fetal heart rate should be monitored regularly and closely to detect any abnormalities. The dose and route of administration should be determined to avoid inaccurate dosing. The drug should be discontinued after contractions cease. The client should be placed in the left lateral recumbent position to increase blood flow to the fetus and to increase renal blood flow.
A pregnant woman continues consuming alcohol during pregnancy. Which teratogenic effects might be seen in the fetus or neonate? Select all that apply. 1 Stillbirth 2 Ebstein anomaly 3 Neural tube defects 4 Spontaneous abortion 5 Intellectual disabilities
Answer: 1, 4, 5 Prolonged fetal exposure to alcohol may cause a stillbirth. A spontaneous abortion may occur if the pregnant woman consumes alcohol in excess amounts. Intellectual disabilities may be seen in the neonate if it is exposed to alcohol in the fetal stage. Ebstein anomaly is caused by lithium exposure during pregnancy. Neural tube defects may be due to exposure to antiseizure drugs during pregnancy.
The nurse reviews a female client's prescription and informs the client that there could be a risk of multiple pregnancies. Which drug might have been prescribed to the client? 1 Nifedipine 2 Clomiphene 3 Menotropins 4 Methylergonovine
Answer: 2 Clomiphene is a fertility drug used to promote ovulation in nonpregnant women. Clients taking this drug should be counseled about the possibility of multiple pregnancies. Nifedipine is used to inhibit labor and maintain pregnancy. This drug has potential maternal and fetal risks. Menotropins and methylergonovine are not associated with multiple pregnancies.
A pregnant woman was exposed to a teratogenic drug during her first trimester. Which nursing interventions would be beneficial to the client? Select all that apply. 1 Ultrasound scanning should be avoided. 2 The woman should be referred for evaluation. 3 The woman's pregnancy should be terminated even if minor malformations are found. 4 The woman should be educated about the risks of drug-induced malformations. 5 The woman should be assured that the risk is minimal if the malformation is minor
Answer: 2, 4, 5 If a pregnant woman is exposed to a teratogenic drug, further evaluation is needed to determine the type of malformation that can be expected. The woman should be educated about the effects of drugs on the fetus so she can avoid being exposed to drugs with teratogenic effects. If the malformations are minor, the woman should be assured the risk is minimal and can be corrected by surgery. Ultrasound scanning should be done to assess the extent of the injury. The pregnancy should be terminated only if the malformation is severe. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.
Which gestational period is appropriate for the administration of corticosteroids during preterm labor? 1 Less than 20 weeks 2 20 to 24 weeks 3 24 to 34 weeks 4 More than 34 weeks
Answer: 3 If preterm labor occurs during 24 to 34 weeks of gestation and if labor is unavoidable, corticosteroids should be administered to promote lung maturity. Labors occurring before 20 weeks of gestation usually results in a nonviable fetus; corticosteroids would not need to be administered. Corticosteroids do not promote lung maturation during 20 to 24 weeks of gestation. Fetal lungs mature at 34 weeks of gestation. A fetus in this period of gestation would not require the administration of corticosteroids if labor is unavoidable.
A client who is at 33 weeks' gestation has contracted gonorrhea and is prescribed probenecid and penicillin. What instructions will the nurse give to the client regarding the reason for dual therapy? 1 "Your allergy to penicillin is minimized." 2 "The side effects of the disease are reduced." 3 "Your immune defense mechanisms are more active." 4 "The amount of penicillin in your blood is increased."
Answer: 4 Probenecid reduces renal tubular excretion of penicillin. The options "Your allergy to penicillin is minimized", "The side effects of the disease are reduced," and "Your immune defense mechanisms are more active" are unrelated to the concomitant administration of penicillin and probenecid. STUDY TIP: Regular exercise, even if only a 10-minute brisk walk each day, aids in reducing stress. Although you may have been able to enjoy regular sessions at the health club or at an exercise class several times a week, you now may have to cut down on that time without giving up a set schedule for an exercise routine. Using an exercise bicycle that has a book rack on it at home, at the YMCA, or at a health club can help you accomplish two goals at once. You can exercise while beginning a reading assignment or while studying notes for an exam. Listening to lecture recordings while doing floor exercises is another option. At least a couple of times a week, however, the exercise routine should be done without the mental connection to school; time for the mind to unwind is necessary, too.
