Reproductive/Maternity/Newborn medications

Correct Answer: 3, 4 Rationale: Oxytocin stimulates uterine contractions and is a common pharmacological method to induce labor. High-dose protocols have been associated with more uterine hyperstimulation and more cesarean births related to fetal stress. Late decelerations, a nonreassuring fetal heart rate pattern, is an ominous sign indicating fetal distress. Some PHCPs prescribe the administration of oxytocin in 10-minute pulsed infusions rather than as a continuous infusion. This pulsed method, which is more like endogenous secretion of oxytocin, is reported to be effective for labor induction and requires significantly less oxytocin use. Oxytocin infusion must be stopped when any signs of uterine hyperstimulation are present. Drowsiness and fatigue may be caused by the labor experience. Early decelerations of the fetal heart rate are a reassuring sign and do not indicate fetal distress.

1. The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment findings should cause the nurse to immediately discontinue the oxytocin infusion? Select all that apply. 1.Fatigue 2.Drowsiness 3.Uterine hyperstimulation 4.Late decelerations of the fetal heart rate 5.Early decelerations of the fetal heart rate

1. Naloxone Rationale: Opioids are used for epidural analgesia. An adverse reaction of epidural analgesia is a delayed respiratory depression. Respirations are monitored for 24 hours after administration of epidural analgesia. Naloxone is an opioid antagonist that reverses the effects of opioids and is given if respirations fall below 6 to 8 per minute. Morphine sulfate and meperidine hydrochloride are opioids and are contraindicated because no additional opioids are to be administered during the first 24 hours. Betamethasone is a corticosteroid administered to enhance fetal lung maturity.

11. The postpartum nurse is caring for a client following a cesarean birth who received epidural analgesia. The client is lethargic and is exhibiting signs of respiratory depression. The nurse suspects that the respiratory depression is caused by the epidural analgesia. The nurse notifies the registered nurse immediately and prepares the client for the administration of which medication? 1.Naloxone 2.Betamethasone 3.Morphine sulfate 4.Meperidine hydrochloride

2. " This medication will promote fetal lung maturity." Rationale: Betamethasone, an anti-inflammatory corticosteroid, is given to increase the surfactant level and increase fetal lung maturity, reducing the incidence of respiratory distress syndrome. Delivery of the baby needs to be delayed for at least 48 hours after administration of betamethasone in order to allow time for the lungs to mature. Surfactant production does not become stable until after 32 weeks of gestation, and if adequate amounts of surfactant are not present in the lungs, respiratory distress and death are possible. Options 1, 3, and 4 are incorrect.

12. The nursing student is assigned to care for a 30-week gestational woman who is admitted to the maternity unit in preterm labor. Betamethasone is prescribed to be administered to the mother. The nursing instructor asks the student about the purpose of the medication. Which statement by the student indicates an understanding of the purpose of this medication? 1."This medication will delay delivery." 2."This medication will promote fetal lung maturity." 3."This medication will prevent membrane rupture." 4."This medication will stop the premature uterine contractions."

1. Absence of deep tendon reflexes Rationale: Adverse side effects with magnesium sulfate include central nervous system depression. The nurse monitors the client to ensure that the respiratory rate is greater than 12 breaths per minute, that the urine output is greater than 30 mL/hour, and that deep tendon reflexes are present. A decrease in blood pressure is a positive finding. The absence of deep tendon reflexes indicates the need to discontinue the infusion of this medication.

15. A client diagnosed with severe preeclampsia is on magnesium sulfate by continuous intravenous infusion. Which finding suggests to the nurse that the next dose of this medication should be held? 1.Absence of deep tendon reflexes 2.Urinary output of 45 mL in the past hour 3.Respiratory rate of 20 breaths per minute 4.Decrease in blood pressure from 180/100 to 150/90 mm Hg

1. Heart and lungs Rationale: Terbutaline sulfate affects the smooth muscles of the uterus, which decreases contractions. It also affects the contractibility of the smooth muscles of the heart and lungs and can cause serious complications to the cardiopulmonary systems. It does not affect the kidneys or gastrointestinal tract.

16. The nurse is caring for a client in preterm labor who is receiving terbutaline sulfate to stop uterine activity. During this medication therapy, the nurse implements nursing interventions to monitor which specific body organs that can be affected by this medication? 1.Heart and lungs 2.Kidneys and lungs 3.Heart and kidneys 4.Lungs and gastrointestinal tract

Correct Answer:3, 6 Rationale: Vitamin K is administered within the first hour of birth to prevent hemorrhagic disease of the newborn. Antibiotic ophthalmic solutions are required prophylaxis to prevent ophthalmic neonatorum due to Neisseria gonorrhoeae or Chlamydia and are given within the first hour after birth. Hepatitis B vaccine is administered before baby discharge. Hepatitis A vaccine may or may not be required. Naloxone is used to treat respiratory depression. Lung surfactant, administered by direct intratracheal instillation, is indicated for prevention and treatment (rescue therapy) of respiratory distress syndrome (RDS).

19. The nurse in the delivery room is caring for a newborn delivered 10 minutes ago. The nurse assists in preparing which medications that will be prescribed to be given within the first hour of life? Select all that apply. 1.Naloxone 2.Surfactant 3.Phytonadione 4.Hepatitis A vaccine 5.Hepatitis B vaccine 6.Erythromycin eye drops

2. Blood pressure Rationale: Methylergonovine, an ergot alkaloid, is used to prevent or control postpartum hemorrhage by contracting the uterus. Methylergonovine causes continuous uterine contractions and may elevate the blood pressure. A priority assessment before the administration of the medication is to check the blood pressure. The HCP should be notified if hypertension is present. Although options 1, 3, and 4 may be components of the postpartum assessment, the correct option, blood pressure, is related specifically to the administration of this medication.

20. Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority nursing assessment? 1.Uterine tone 2.Blood pressure 3.Amount of lochia 4.Deep tendon reflexes

2. Betamethasone Rationale: Betamethasone, a glucocorticoid, is given to increase the production of surfactant to stimulate fetal lung maturation. It is administered to clients in preterm labor at 28 to 32 weeks of gestation if the labor can be inhibited for 48 hours. Nalbuphine is an opioid analgesic. Rho(D) immune globulin is given to Rh-negative clients to prevent sensitization. Dinoprostone vaginal insert is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions.

5. A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate and her contractions have stopped. If the client's labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication? 1.Nalbuphine 2.Betamethasone 3.Rho(D) immune globulin 4.Dinoprostone vaginal insert

Correct Answer: 2, 4 Rationale: Magnesium toxicity can occur from magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden decline in fetal heart rate and maternal heart rate and blood pressure. Urine output should be at least 25 mL to 30 mL per hour. Therapeutic serum levels of magnesium are 4 mEq/L to 7 mEq/L (2 to 3.5 mmol/L). Proteinuria of 3+ is an expected finding in a client with preeclampsia.

2. A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted during assessment? Select all that apply. 1.Proteinuria of 3+ 2.Respirations of 10 breaths/minute 3.Presence of deep tendon reflexes 4.Urine output of 20 mL in an hour 5.Serum magnesium level of 6 mEq/L (3 mmol/L)

Correct Answer: 1, 4, 5 Rationale: Magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus. It is used to halt preterm labor contractions and is used for preeclamptic clients to prevent seizure. Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.

3. The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? Select all that apply. 1.Flushing 2.Hypertension 3.Increased urine output 4.Depressed respirations 5.Extreme muscle weakness 6.Hyperactive deep tendon reflexes

1. " I will flush the eyes after instilling the ointment." Rationale: Eye prophylaxis protects the newborn against Neisseria gonorrhoeae and Chlamydia trachomatis. The eyes are not flushed after instillation of the medication because the flush would wash away the administered medication. Options 2, 3, and 4 are correct statements regarding the procedure for administering eye medication to the newborn.

4. The nursing instructor asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which student statement indicates that further teaching is needed? 1."I will flush the eyes after instilling the ointment." 2."I will clean the newborn's eyes before instilling ointment." 3."I need to administer the eye ointment within 1 hour after delivery." 4."I will instill the eye ointment into each of the newborn's conjunctival sacs."

1. Naloxone Rationale: Opioid analgesics may be prescribed to relieve moderate to severe pain associated with labor. Opioid toxicity can occur and cause respiratory depression. Naloxone is an opioid antagonist, which reverses the effects of opioids and is given for respiratory depression. Morphine sulfate and meperidine hydrochloride are opioid analgesics. Betamethasone is a corticosteroid administered to enhance fetal lung maturity.

7. An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily available if respiratory depression occurs? 1.Naloxone 2.Morphine sulfate 3.Betamethasone 4.Meperidine hydrochloride

4. Decrease tachypnea and nasal flaring Rationale: Lung surfactant, administered by direct intratracheal instillation, is indicated for prevention and treatment (rescue therapy) of respiratory distress syndrome (RDS). Surfactant therapy lowers the surface-tension forces that cause alveolar collapse and thereby rapidly improves oxygenation evidenced by decreased respiratory rate (tachypnea) and nasal flaring. Decreased acrocyanosis, improved cardiac output and increased body temperature are not therapeutic outcomes of this medication.

18. The nurse is assisting in monitoring a preterm infant in the neonatal intensive care unit who received surfactant. The nurse monitors for which desired therapeutic outcome of this medication? 1.Decreased acrocyanosis 2.Improved cardiac output 3.Increased body temperature 4.Decreased tachypnea and nasal flaring

2. Intratracheal Rationale: Respiratory distress syndrome is a serious lung disorder caused by immaturity and the inability to produce surfactant, resulting in hypoxia and acidosis. It is common in premature infants and may occur as a result of lung immaturity caused by surfactant deficiency. The mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route. Options 1, 3, and 4 are not routes of administration for this medication.

6. The nurse is preparing to administer beractant to a premature infant who has respiratory distress syndrome. The nurse plans to administer the medication by which route? 1.Intradermal 2.Intratracheal 3.Subcutaneous 4.Intramuscular

4. Blood pressure Rationale: Methylergonovine is an ergot alkaloid used for postpartum hemorrhage. It stimulates contraction of the uterus and causes arterial vasoconstriction. Ergot alkaloids are avoided in clients with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. The nurse should check the client's blood pressure before administering the medication and should follow agency protocols regarding withholding of the medication. Temperature, lochial flow, and urine output are items that are checked in the postpartum period, but they are unrelated to the use of this medication.

10.Methylergonovine is prescribed for a client with postpartum hemorrhage caused by uterine atony. Before administering the medication the nurse checks which important client parameter? 1.Temperature 2.Lochial flow 3.Urine output 4.Blood pressure

2. "It increase acetylcholine and blocks neuromuscular transmission." Rationale: Magnesium sulfate produces flushing and sweating as a result of decreased peripheral blood pressure; decreases the central nervous system responses and acts as an anticonvulsant; decreases the frequency and duration of uterine contractions; and decreases acetylcholine, blocking neuromuscular transmission.

13. Magnesium sulfate is prescribed for a client with severe preeclampsia. Which statement by the student nurse indicates the need for further teaching regarding the action of this medication? 1."It decreases the frequency and duration of uterine contractions." 2."It increases acetylcholine and blocks neuromuscular transmission." 3."It decreases the central nervous system responses, acting as an anticonvulsant." 4."It produces flushing and sweating as a result of decreased peripheral blood pressure."

4. Being affected by Rh incompatibility Rationale: Rh incompatibility can occur when an Rh-negative mother becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the fetus's Rh-positive blood can enter the maternal circulation, causing the mother's immune system to form antibodies against Rh-positive blood. Administration of Rho(D) immune globulin prevents the mother from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen.

8 . Rho(D) immune globulin is prescribed for a client after delivery and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose if the woman states that it will protect her next baby from which condition? 1.Having Rh-positive blood 2.Developing a rubella infection 3.Developing physiological jaundice 4.Being affected by Rh incompatibility

Correct Answer: 1,2, 3, 5 Rationale: Magnesium sulfate is effective when the deep tendon reflexes are not hyperreflexive, the urine output is at least 30 mL per hour, and the respiratory rate is at least 12 breaths/minute. The therapeutic range for magnesium sulfate is approximately 5 to 8 mg/dL. The respiratory rate of 10 breaths per minute may indicate the client is becoming toxic on the magnesium sulfate.

14. A client with severe preeclampsia is receiving magnesium sulfate by intravenous infusion. Which criteria indicate expected findings for this medication? Select all that apply. 1.Deep tendon reflexes at 2+ 2.Magnesium level of 7 mg/dL 3.Urine output of 30 mL per hour 4.Respiratory rate of 10 breaths/minute 5.Feeling of warmth, flushing and diaphoresis

4. Monitor for increase in maternal and fetal heart rates. Rationale: Calcium is essential for muscle contraction in smooth muscles, such as the uterus, so blocking calcium reduces the muscular contraction. Flushing of the skin, headache, and a transient increase in the maternal and fetal heart rates are common side effects. These medications can vasodilate so the woman is at risk for orthostatic hypotension.

17. The nurse is assisting in preparing a plan of care for a client who will be receiving a calcium antagonist to prevent preterm delivery. Which action does the nurse include in the plan of care for the client to detect a side effect of the medication? 1.Monitor for hypertension. 2.Monitor for pale and dry skin. 3.Monitor for fluid volume deficit. 4.Monitor for increases in maternal and fetal heart rates.

4. Peripheral vascular disease Rationale: Methylergonovine is an ergot alkaloid used to treat postpartum hemorrhage. Ergot alkaloids are contraindicated in clients with significant cardiovascular disease, peripheral vascular disease, hypertension, preeclampsia, or eclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. Options 1, 2, and 3 are not contraindications related to the use of ergot alkaloids.

9. Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse contacts the primary health care provider (PHCP) who prescribed the medication if which condition is documented in the client's medical history? 1.Hypotension 2.Hypothyroidism 3.Diabetes mellitus 4.Peripheral vascular disease