1232 exam eaq 3 drugs
A mother of a newborn asks the nurse if breastfeeding while taking methyldopa is permitted. How should the nurse respond?
"Another antihypertensive may be safer to use in the postpartum period."
The mother asks the nurse why her newborn is being given both the hepatitis B vaccine and HBIG. What is the nurse's best response to the mother?
"Because your blood tested positive for the hepatitis B antigen, we give both vaccines to protect your baby."
A patient with preeclampsia is being given a dose of nifedipine for a BP of 180/115 mm Hg. She expresses concern about the effects of nifedipine on the fetus. What is the best response by the nurse?
"This medication is used only when its potential benefits outweigh the risks to the baby"
A student nurse is asking about a 3-day-old newborn's ability to produce vitamin K. By what age can healthy newborns produce their own vitamin K?
1 week
The nurse is preparing to administer Rho(D) IG to an Rh-negative mother who delivered a full-term infant 48 hours ago. What is the usual dose of Rho(D) IG?
300 mcg Rho(D) IG
For how long can terbutaline be safely used in the suppression of preterm labor before it is discontinued
48 hours
What supplies does the nurse know to collect before administering Engerix-B® to a newborn?
A prefilled syringe with 10 mcg of medication and a ⅝-in needle
The nurse is preparing to administer nifedipine as a first-line drug for managing acute-onset, severe hypertension. What is the BP range that should be treated?
A systolic BP greater than or equal to 160 mm Hg or a diastolic BP greater than or equal to 110 mm Hg lasting 15 minutes or longer
A patient in labor at 40 weeks' gestation requires a dose of ephedrine for postepidural hypotension. After administering ephedrine 10 mg IV, the nurse can expect which effect?
An increase in FHR
A patient at 38 weeks' gestation who has chronic hypertension with superimposed preeclampsia is having labor induced. What are contraindications to labetalol?
Asthma, AV block, and heart failure
A patient who was receiving a magnesium sulfate infusion to treat eclampsia experienced magnesium toxicity and has just received an IV dose of calcium gluconate. The nurse should monitor this patient for which potentially life-threatening adverse reactions to calcium gluconate?
Bradycardia, cardiac arrhythmias, and cardiac arrest
A nurse obtains a health history from a patient who is schedules to take a combination OC. Which factor in the patient's history would prompt the nurse to contact the physician immediately?
Breast cancer
A postpartum patient is being discharged home with a prescription for labetalol, 300 mg by mouth twice daily. She will be taking the medication until her 4-week postpartum checkup with her practitioner. During discharge teaching, the nurse reminds the patient about the common adverse effects of labetalol. What are these effects?
Dizziness, nausea or vomiting, and fatigue
A patient at 37 weeks' gestation has just received a dose of methyldopa. The nurse knows the potential maternal adverse reactions to methyldopa are similar to those of other antihypertensives. What are some of the adverse reactions that the patient may experience?
Drowsiness, headache, muscle weakness, nausea, vomiting, dry mouth, rash, and orthostatic hypotension
Which type of OC delivers hormones for more than 30 days?
Extended cycle
A patient who is infertile is taking clomiphene. The nurse should expect the patient to have which therapeutic response?
Follicular maturation
Which instruction will the fertility nurse give to the couple after taking menotropins?
Have intercourse on the evening before human chorionic gonadotropin (hCG) injection and on the following 2 to 3 days
What are some of the common adverse effects of misoprostol when given for postpartum hemorrhage?
Headache, nausea, vomiting, diarrhea, fever, and chills
A female patient is prescribed bromocriptine therapy. Which endocrine disorder will the nurse most likely observe written in the chart?
Hyperprolactinemia
Two days ago, a patient with Type 1 diabetes delivered a term newborn. The mother is breastfeeding the infant, and the infant is feeding every 3 hours for 30 minutes. The practitioner restarts the mother's sliding scale regular insulin orders. This patient has a risk of which complication?
Hypoglycemia
A nurse is preparing to administer a repeat dose of labetalol to an antepartum patient with preeclampsia and a BP of 170/110 mm Hg. If the BP does not drop below 160/110 mm Hg or increases, how soon can a repeat dose of labetalol IV be administered?
In 10 minutes
A primigravida presents to the labor and delivery unit with severe preeclampsia. BP is 210/110 mm Hg. The practitioner orders hydralazine by IV push administration. Which is the primary advantage of administering hydralazine?
It increases cardiac output.
A multigravida patient at 39 weeks' gestation is being induced for type 2 diabetes. The nurse is explaining to a new nurse about the impact diabetes can have on the newborn. Newborns of patients with diabetes have a higher risk of which complications?
Malformations, macrosomia, shoulder dystocia, birth injury, hypocalcemia, hypoglycemia, and respiratory distress syndrome
A 2-day-old newborn begins bleeding profusely from the umbilical cord site. The nurse applies pressure to the site and, upon reviewing the newborn's record, learns that the newborn did not receive vitamin K at birth because the mother refused. Which risk factor associated with classic-onset VKDB might the nurse find in this newborn's record?
Nutrition obtained via breastfeeding
A nurse is about to administer erythromycin ointment to a newborn and notices that the newborn's right eye is draining yellow discharge. What should the nurse do first?
Obtain a specimen for culture and sensitivity testing and cleanse the eye before administration.
A patient who take an angiotensin-converting enzyme (ACE) medication is scheduled to be taking the drospirenone/ethinyl estradiol OC. Which laboratory results should the nurse monitor during the first cycle of use?
Potassium level
A nurse is teaching a group of pregnant women to have early screening and treatment of asymptomatic bacterial vaginosis with antibiotics. What is the nurse trying to prevent?
Preterm labor
A patient at 30 weeks' gestation presents to the obstetric triage unit "for a steroid shot." What should be the nurse's first intervention?
Review the practitioner's order.
A multigravida delivered 1 day ago at 40 weeks' gestation. On admission, the admitting nurse is informed that the patient is of the Jehovah's Witnesses faith. The patient is A negative, and the practitioner has ordered Rho(D) IG to be administered. What should the nurse's next action be?
Teach the patient that Rho(D) IG is made from human plasma before administering it.
What is an unexpected outcome of eye prophylaxis?
The newborn has mildly red eyes.
Why is erythromycin ophthalmic ointment given to newborns?
To prevent blindness
A student nurse asks the nurse which routes are safe for calcium gluconate administration. How should the nurse respond?
Calcium gluconate is for IV use only.
Which medication is an alternative to erythromycin 0.5% ophthalmic ointment for newborns at risk of exposure to N. gonorrhoeae?
Ceftriaxone 25 to 50 mg/kg intravenously or intramuscularly
A nurse administered a medication to promote follicular maturation in an infertile female patient. Which medication did the nurse most likely administer?
Clomiphene
Which medication may cause production of unfavorable cervical mucus?
Clomiphene
A patient is found to have insufficient cervical mucus. The healthcare provider would likely prescribe which medication to facilitate conception?
Estrogen
During labor, a multipara being treated with magnesium sulfate for preeclampsia receives a dose of IV hydralazine because her BP is 180/114 mm Hg. The combination of magnesium sulfate and hydralazine places the patient at an increased risk of which complication?
Hypotension
A patient who is at 39 weeks' gestation presents to the labor and delivery unit with chronic hypertension. BP is 210/110 mm Hg, and the patient has no signs or symptoms of preeclampsia. The practitioner orders labetalol IV push. What is one advantage of labetalol administration over hydralazine administration that the nurse should know?
Labetalol is less likely to cause excessive hypotension and rebound hypertension.
The practitioner has ordered two doses of terbutaline 0.25 mg subcutaneously for a patient at 30 weeks' gestation. Before administering the second dose, what should the nurse assess?
Maternal apical heart rate and lung sounds
What is the priority nursing intervention for a patient who is taking combines OC pills with drospirenone?
Monitoring serum potassium levels
Which statement regarding the practice of giving newborns vitamin K immediately after birth is most accurate?
Newborns' GI systems are sterile, resulting in a lack of vitamin K production.
Which condition should the nurse monitor for in a patient who is taking lauprolide for endometriosis?
Osteoporosis
A patient received a combination of mifepristone and oral misoprostol for medically induced abortion. On discharge, the nurse is explaining which symptoms to report to the practitioner immediately. What should the list include?
Severe abdominal tenderness
The nurse receives an order to administer magnesium sulfate to a patient with preterm labor to delay delivery and thus provide time for fetal lung maturity. Before initiating the infusion, the nurse should instruct the patient to report which sign or symptom?
Shortness of breath
Which type of medication will the nurse expect to administer to a patient in preterm labor?
Tocolytics
An orientee asks about IM injections in newborns because her only practice experiences have been with adults. What is the correct injection site for an IM injection in the newborn?
Vastus lateralis muscle
A primipara who delivered vaginally 2 hours ago is transferred with the newborn to the postpartum unit. During the change-of-shift report, the nurse assuming the patient's care is told that the patient has B-negative blood and that cord blood has been sent to the laboratory. What is the first step the nurse should take in following up with the care of this patient and newborn?
Verify that a Coombs test was ordered for the patient.
A nurse is administering human chorionic donadotropin (hCG). Which action is appropriate?
When used in conjunction with menotropins, administer 1 day after the last menotropins dose
For a medically induced abortion, the FDA-approved mifepristone-misoprostol combination can be used up to how many weeks of gestation?
10 weeks
When administering vitamin K, the nurse should avoid which action?
Administering vitamin K into the rectus femoris muscle
A newborn has been diagnosed with early VKDB. Which medications are associated with this condition?
Anticoagulants
The student nurse asks the nurse how methyldopa is excreted in the body. How should the nurse respond?
"Methyldopa is primarily excreted by the kidneys."
The nurse is teaching students about progestin-only OCs. Which statement by a student indicates effective learning?
'They may cause breakthrough bleeding.'
Which statement should the nurse make to inform a patient about the benefit of taking norethindrone acetate and ethinyl estradiol and ferrous sulfate?
'This pill will prevent iron-deficiency anemia associated with menstruation.'
How long should the nurse expect ephedrine's vasopressor effects to last?
1 hour
When does gonococcal infection typically manifest in newborns?
2 to 5 days after birth
The nurse should report which finding of ovarian hyperstimulation in a woman receiving menotropins
Ascites and weight gain
The nurse is preparing to administer an IM injection of vitamin K to a newborn. During the procedure, what is the most appropriate comfort measure for the newborn?
Asking the mother to breastfeed the newborn
A nurse is preparing to administer methylergonovine. Which assessment is essential before administering?
Determine passage of the placenta
Which medication classification is associated with a risk for the development of valvular heart disease?
Ergo derivatives
A newborn needs both hepatitis B vaccine and HBIG. How should the nurse administer the injections?
Give the medications at the same time, but use separate injection sites.
How should the nurse administer eye ointment?
Hold the applicator above the lower lid margin and evenly apply a thin ribbon of ointment 1 cm (0.4 in) long along the inner edge of the lower eyelid starting at the inner canthus.
A patient at 27 weeks' gestation is admitted for a 23-hour observation period to rule out preterm labor. The practitioner orders terbutaline. The order reads terbutaline 5 mg subcutaneously every 3 to 4 hours for contractions greater than six per hour. Based on this order, what should the nurse do?
Immediately clarify the order with the practitioner because it is unusual.
A pregnant patient with chronic hypertension is hospitalized for 23-hour observation to rule out preeclampsia. The practitioner orders labetalol 200 mg to be administered intravenously every 10 minutes if the patient's BP is more than 160/110 mm Hg. Based on this order, what should the nurse do?
Immediately clarify the practitioner's order.
A primigravida at 40 weeks' gestation is admitted for induction of labor. The patient has been diagnosed with GDM and is receiving insulin injections at home. Besides setting up for a vaginal delivery, what should the nurse do?
Notify the perinatal team and be prepared for cesarean delivery.
A patient is prescribed clomiphene 50 mg/day for 5 days. Which assessment finding would best indicate a need to increase dosage?
Ovulation did not occur
Which condition is a contraindication to misoprostol administration?
Previous uterine surgery
Which mechanism of action is accurate for clomiphene?
Promotion of follicle stimulating hormone (FSH) and lutenizing hormone (LH) release
Which medication is most likely to decrease the effectiveness of norethindrone and ethinyl estradiol?
Rifampin
Which assessment finding indicates a male patient is having a therapeutic response to follitropin alfa?
Sperm count increases
A primigravida receiving hydralazine for hypertension is concerned about the drug's effects on the baby. The patient asks the nurse, "Will this medicine harm my baby?" How should the nurse respond?
Tell the patient that the amount of drug that crosses the placenta is very small.
What is the medication classification of hydralazine?
Vasodilator
As the nurse prepares to administer ephedrine to a patient who has low blood pressure postepidural, the patient states, "I don't want that medication." How should the nurse respond?
"What is your concern about receiving the medication?"
Which statement should the nurse use to instruct a patient who takes a progestin-only oral contraception pill (POP)?
'Take 1 pill daily at the same time of day.'
The nurse is preparing to administer a dose of labetalol IV push to a patient at 36 weeks' gestation who presented in the triage area 30 minutes ago. The patient had her BP measured two times 15 minutes apart, and both readings were more than 160/110 mm Hg. Over what period of time should the nurse administer the IV push dose of labetalol?
2 minutes
A patient at 38 weeks' gestation is receiving magnesium sulfate for preeclampsia with severe features. The practitioner has ordered serum magnesium levels every 8 hours. What is the therapeutic target range for serum magnesium levels?
5 to 8 mEq/L
A patient is receiving dinoprostone gel prior to induction of labor. At which time is oxytocin administered in this scenario?
6 to 12 hours following the last dose of dinoprostone
Use which drug is most likely to result in multiple births?
Menotropins
Which medications act directly on the ovary to promote follicular development?
Menotropins , Lutropin alfa
A patient is anovulatory. When checking the chart, which drugs will the nurse most likely observe prescribed to promote follicular maturation and ovulation?
Menotropins and human chorionic gonadotropin (hCG)
A patient is prescribed clomiphene 50mg/day for 5 days. Which assessment finding would best indicate a need to increase the dosage?
Ovulation did not occur
A patient has just presented to the triage area at 37 weeks' gestation with a BP of 180/112 mm Hg. After 15 minutes, the patient's BP is 180/104 mm Hg. The practitioner orders a dose of labetalol 20 mg IV push. The nurse tries to insert an IV line two times but is unsuccessful. What is the appropriate next action?
Request an order for labetalol 200 mg by mouth from the practitioner.
When a patient's blood is Rh negative and the fetal blood is Rh positive, what is the risk to the fetus during pregnancy?
The maternal immune system becomes sensitized to the Rh positive factor and destroys fetal red blood cells.
A patient with newly diagnosed GDM presents to the labor and delivery unit at 28 weeks' gestation for instruction on insulin self-administration. The practitioner has ordered intermediate-acting insulin to be administered on a schedule and a short-acting insulin to be administered as needed. The patient begins to prepare the first injection of intermediate insulin and starts to shake the bottle to "mix the cloudy solution." Which patient instruction is appropriate?
"Cloudy insulin should be gently rolled to mix; it should not be shaken."
A primipara at 39 weeks' gestation presents to the labor and delivery unit for cervical ripening to be followed by labor induction. The practitioner orders misoprostol to be administered vaginally every 6 hours as needed to achieve a Bishop score of 8 or greater or until labor begins. A nursing student on the unit asks the nurse why misoprostol is being given first instead of oxytocin. What is the nurse's most accurate response?
"Misoprostol is used first to soften and thin the cervix, which may reduce the amount of oxytocin needed to induce labor."
A patient is receiving calcium gluconate IV for magnesium toxicity. A nurse enters the room to assist with the emergency and notices that the primary nurse is injecting the calcium gluconate rapidly. The assisting nurse should advise the primary nurse to administer the calcium gluconate at which rate?
1 g/3 min
The nurse administers one dose of immediate-release nifedipine 10 mg orally to a patient at 37 weeks' gestation who is being induced for preeclampsia and who has a BP of 175/114 mm Hg. How long must the BP remain elevated before a second dose of nifedipine can be given?
20 minutes
A patient receiving magnesium sulfate for preeclampsia has just delivered a term newborn. After the delivery, magnesium sulfate is usually continued for how long to prevent seizures?
24 hours
Which preprandial maternal capillary glucose level does the American Diabetes Association recommend for patients with GDM?
95 mg/dl or less
A 40-year-old multipara presents to the antepartum unit for amniocentesis at 18 weeks' gestation. The patient has A-negative blood and a negative response to the Coombs test. Which treatment should the nurse anticipate?
Administer Rho(D) IG because the patient is Rh negative, is not sensitized to the Rh factor, and will undergo an invasive procedure that may cause fetal blood to cross into maternal blood.
A nurse is administering terbutaline 0.25 mg subcutaneously as ordered by the practitioner. The patient's heart rate is 150 beats per minute, blood pressure is 88/55 mm Hg, and the patient is shaking and complaining of chest discomfort. Which order can the nurse anticipate receiving?
Administer propranolol.
A mother who received oral methyldopa during the last 5 months of pregnancy has delivered, and the newborn has successfully completed the transition period with no complications. Later, the nurse notices that the newborn's blood work shows a positive direct antiglobulin test (DAT) result. Why should the nurse report this to the practitioner?
Based on the maternal history, the practitioner will probably want to rule out hemolytic anemia in the newborn.
A patient at 36 weeks' gestation is in preterm labor. The nurse caring for the patient knows that tocolytics are not usually used after 34 weeks' gestation. Why are tocolytics not recommended after 34 weeks' gestation?
Because of their possible adverse effects
The nurse is assessing a 38-year old patient who uses a combined hormone contraception (CHC) product. The nurse finds that the patient is a frequent smoker. Which assessment parameter is of highest priority in this case?
Blood pressure readings
A patient is to receive IV ephedrine for hypotension after epidural placement. The order reads "ephedrine 50 mg IV every 10 minutes as needed." Based on this order, what should the nurse do?
Clarify the order because the usual dose for IV ephedrine is 5 to 10 mg
A patient at 38 weeks' gestation is admitted to the labor and delivery unit with preeclampsia. The patient's BP is 198/122 mm Hg. The practitioner orders methyldopa 250 mg to be given orally every 8 hours for BP over 160/100 mm Hg. Which nursing intervention is appropriate?
Clarify the order with the practitioner because methyldopa's effect on BP is delayed 4 to 6 hours.
A patient with chronic hypertension is admitted for a 23-hour observation period to rule out preeclampsia. The practitioner writes this order: "Nifedipine 200 mg orally every 10 minutes for BP over 160/110 mm Hg." Which action should the nurse perform next?
Clarify the practitioner's order because the initial dose for nifedipine is 10 mg.
A patient at 28 weeks' gestation is admitted for 23-hour observation. The patient is pregnant with twins and reports irregular contractions that are increasing in frequency. The practitioner has ordered betamethasone 6 mg IM every 12 hours. What should be the first nursing intervention?
Clarify the practitioner's order because the usual dosage for betamethasone is 12 mg every 24 hours for a total of two doses.
A multipara with preeclampsia is hospitalized for a 23-hour observation period. The practitioner orders IV hydralazine. The order says to administer an initial dose of 50 mg IV for BP over 160/110 mm Hg. Based on this order, what should the nurse do?
Clarify the practitioner's order.
A patient at 39 weeks' gestation is admitted for induction of labor after receiving a cervical ripening medication throughout the night. The patient received a scheduled dose of methyldopa 4 hours ago for elevated BP related to chronic hypertension. The nurse completes an hourly assessment, and the patient's BP is 158/90 mm Hg, the FHR is Category I (normal), and the patient is reporting headache, nausea, and drowsiness. Which nursing action is appropriate?
Continue to monitor the patient closely and emphasize that these are common adverse reactions to methyldopa.
A patient at 26 weeks' gestation received a course of betamethasone 7 days ago. This patient will have a cesarean delivery because of preeclampsia with severe features. What effects should the antenatal corticosteroid therapy have on the newborn?
Decreased risk of neonatal intraventricular hemorrhage, RDS, and necrotizing enterocolitis
A laboring patient with preeclampsia has a BP of 198/112 mm Hg. The practitioner orders 10 mg of oral nifedipine. About 25 minutes after administering the nifedipine, the nurse observes that the patient's BP is 112/58 mm Hg and that the FHR has absent variability and a new onset of late decelerations. What is the most likely cause of the change in the FHR pattern?
Decreased uteroplacental perfusion
A laboring patient with severe preeclampsia has a BP of 198/112 mm Hg and is receiving IV magnesium sulfate and oxytocin. The practitioner orders 40 mg of labetalol to be administered intravenously. The nurse administers the medication as ordered. Ten minutes later, the nurse obtains a BP reading of 120/72 mm Hg and observes that the FHR pattern now has no variability and a new onset of late decelerations. What does the nurse know is the most likely cause of the change in FHR pattern?
Decreased uteroplacental perfusion
A multipara with severe preeclampsia has an elevated BP of 198/112 mm Hg. The patient is receiving magnesium sulfate and oxytocin IV. The practitioner orders 10 mg of IV hydralazine. Fifteen minutes after the hydralazine is administered, the nurse observes a maternal BP of 120/72 mm Hg and minimal FHR variability with a new onset of late decelerations. Based on the diagnosis of severe preeclampsia and the current medications being administered, what is the most likely cause of the change in the FHR pattern?
Decreased uteroplacental perfusion
A patient at 39 weeks' gestation presents to the labor and delivery unit with severe preeclampsia. The mother's blood pressure is 210/110 mm Hg. The initial fetal tracing shows a baseline FHR of 140 beats per minute, moderate variability, accelerations, and no decelerations. When the cervix is dilated to 6 cm, an epidural infusion is started to manage the patient's pain. Fifteen minutes after the bolus dose of the anesthesia medication, the patient's blood pressure is 130/68 mm Hg. The patient reports dizziness and feeling light-headed, and the FHR assessment shows a baseline FHR of 160 beats per minute, minimal variability, no accelerations, and recurrent late decelerations. The anesthesia provider orders ephedrine 5 mg IV. Why should the nurse clarify this order?
Ephedrine is contraindicated in a pregnant patient with hypertension during labor.
A patient is concerned about feeling weak and drowsy while on magnesium sulfate for preeclampsia. Which is an appropriate response by the nurse?
Explain that the patient may need calcium gluconate because the patient's magnesium sulfate level may be too high.
The family refuses prophylactic eye ointment for their newborn. Which is the best nursing action?
Explain the risk of not giving treatment and notify the practitioner if they still refuse.
A primigravida with a BP of 180/110 mm Hg needs a dose of IV hydralazine. The patient does not want the hydralazine administered. What should the nurse do?
Explore the patient's concerns about the medication
Which class of medication is administered to accelerate fetal lung development when tocolytics are used to delay delivery?
Glucocorticoids
A patient at 32 weeks' gestation is admitted to the antepartum unit with significantly elevated blood glucose levels; the practitioner wants to rule out gestational diabetes. The patient recently received several doses of subcutaneous terbutaline for preterm contractions. What is one of the potential serious maternal adverse reactions to terbutaline?
Hyperglycemia
A patient is receiving methylergonovine intravenously after a vaginal delivery. Which postpartum complication will the nurse consider when monitoring to prevent complications of therapy?
Hypertension
A nurse receives an order for IV calcium gluconate for a patient experiencing magnesium toxicity from magnesium sulfate therapy. The nurse prepares the injection and enters the patient's room. What should the nurse's initial steps be?
Identify the patient using two identifiers and compare the patient record number on the identification band with the number on the MAR.
The nurse has just administered ephedrine 5 mg IV to a patient who is at 38 weeks' gestation following the administration of an epidural. Which effects on the patient should the nurse expect?
Increased cardiac output and peripheral vasoconstriction
What should the nurse confirm before giving the hepatitis B vaccine and HBIG to a newborn whose mother is HBsAg positive?
Informed consent was obtained.
Which action is part of the proper injection technique for the hepatitis B vaccine?
Inserting the needle at a 90-degree angle
Which education should the nurse provide to the family before administration of eye prophylaxis?
Instruct the family regarding potential side effects and adverse reactions to the medication.
A nurse is preparing to administer to hydroxyprogesterone caproate. Which technique should the nurse use?
Intramuscular (IM) injection into the upper quadrant of the gluteus maximus
Which patient problem should the nurse recognize as a side effect of a progestin-only OC?
Irregular vaginal bleeding
A nurse has just administered dinoprostone gel to a pregnant patient to soften the cervix. What should the nurse do for the next 30 minutes?
Keep the patient supine
A primigravida at 38 weeks' gestation has received two doses of IV hydralazine 20 minutes apart for a BP greater than 160/110 mm Hg. However, the patient's BP remains above 160/110 mm Hg. Which medication and dose should the patient receive next?
Labetalol 20 mg IV administered over more than 2 minutes
When assessing a patient at 34 weeks' gestation with a history of preeclampsia, the nurse finds that the patient's BP is currently 220/110 mm Hg. The nurse calls the practitioner for orders to treat the patient's severe hypertension. What would be an appropriate medication order at this time?
Labetalol or hydralazine
A patient has menorrhagia and wants contraception. Which drug will the nurse most likely see added to the patient's prescriptions?
Levonorgestrel releasing intrauterine system
A patient with chronic hypertension is hospitalized for a 24-hour observation for preterm labor. The patient's BP is 164/100 mm Hg. Antihypertensive medication has not been needed before this admission. The practitioner orders methyldopa 500 mg to be administered orally. For which condition(s) should the nurse assess the patient's history before safely administering the medication?
Liver or kidney disease
A pregnant patient is receiving magnesium sulfate to inhibit uterine contractions. Upon assessment, the nurse observes the patient has loss of deep tendon reflexes. How should the nurse interpret this finding?
Magnesium levels are rising to dangerous levels
Which assessment finding indicates a therapeutic effect for a patient taking nonsteroidal antiinflammatory drugs (NSAIDs) for menorrhagia?
Menstrual bleeding decreases
A nurse reviews the medical history of a patient who is 36 weeks pregnant. which medications does the nurse expect the provider to prescribe for labor induction in the patient?
Misoprostol
The nurse is reviewing the health history of a patient who is pregnant and for whom the practitioner has ordered IV hydralazine for elevated BP. Which condition in the patient's health history is a contraindication to hydralazine administration?
Mitral valve rheumatic disease
Which 28-day regimen is least likely to simulate ovarian production of estrogens and progestins?
Monophasic
Which information is important to share with the patient taking menotropins?
Multiple births are possible
The nurse has just received an order to administer magnesium sulfate to a patient in preterm labor at 31 weeks' gestation. Which condition would prompt the nurse to notify the practitioner because magnesium sulfate is contraindicated?
Myasthenia gravis
A nurse is administering nafarelin for endometriosis. What route of administration will the nurse use?
Nasal
In the triage area, the nurse is caring for a patient at 28 weeks' gestation who presented with contractions every 5 minutes. The practitioner orders nifedipine to decrease the contractions. Which mechanism of action causes such a decrease?
Nifedipine inhibits smooth muscle contractility.
A patient at 33 weeks' gestation has presented with preterm premature rupture of the membranes. On examination, the nurse determines the FHR is 100 bpm and the umbilical cord has prolapsed. What is the next action by the nurse?
Notify the practitioner and prepare for an emergency cesarean birth.
A patient at 28 weeks' gestation is admitted to the antepartum unit in preterm labor, and the practitioner starts magnesium sulfate therapy for neuroprotection of the fetus. Four hours after the magnesium sulfate infusion is initiated, the nurse obtains a specimen for a serum magnesium level. The laboratory calls to report a "critical magnesium value" of 6.2 mEq/L. What is the most appropriate intervention by the nurse?
Notify the practitioner that a therapeutic level of magnesium has been achieved.
A primipara at 42 weeks' gestation has received two doses of misoprostol vaginally; the last dose was 6 hours ago. The nurse completes an assessment to determine the need for additional doses of misoprostol. Performing a sterile vaginal examination, the nurse determines that the patient's cervix is 6 cm dilated, 100% effaced, soft, and at midposition and that the fetus is at -2 station. The patient's membranes are intact, and contractions are occurring every 2 to 3 minutes. Based on these findings, what is the nurse's next appropriate action?
Notify the practitioner that labor has begun.
A primigravida at 40 weeks' gestation with preeclampsia is having labor induced. The patient has received magnesium sulfate for the past 2 days. In the past 2 hours, the patient has been showing signs of magnesium toxicity, with a magnesium level that is now at 10 mEq/L. Which antidote to magnesium sulfate should the practitioner order?
One gram of calcium gluconate (10 ml of 10% solution) intravenously over several minutes
The nurse is about to administer eye ointment to a newborn. Which action takes priority over the other three actions?
Perform hand hygiene and don gloves.
A patient at 32 weeks' gestation presents to the triage area. For the past several hours, the patient has experienced contractions every 5 minutes. On examination, the patient's cervix is 1 cm dilated and 25% effaced. The patient's medical history is negative. On admission, the patient's blood pressure is 110/70 mm Hg and pulse is 115 beats per minute. The practitioner orders one dose of terbutaline 0.25 mg subcutaneously. What is the nurse's response to this order?
Perform the six rights of medication administration and administer the ordered dose.
A patient laboring at 37 weeks' gestation began receiving IV magnesium sulfate for severe preeclampsia. Twenty-five minutes before the start of the magnesium sulfate therapy for a BP of 212/114 mm Hg, the patient received a total of 30 mg oral nifedipine as ordered by the practitioner. The oncoming nurse completes an initial assessment and finds that the patient's BP is now 102/48 mm Hg and her heart rate is 130 bpm and thready. The patient's uterine resting tone and frequency of contractions have increased significantly, and she is reporting dizziness and severe abdominal pain despite having had an epidural. The FHR pattern shows new-onset late decelerations, absent variability, and bradycardia. The nurse should assess the patient for which condition?
Placental abruption
Which strategy should be employed for pain management before administration of a hepatitis B vaccine via the IM route?
Provide nonnutritive sucking or breastfeeding.
A primipara presents to the labor unit for delivery after the demise of the fetus at 22 weeks' gestation. After delivery, the nurse notices that the practitioner has ordered a 50 mcg dose of Rho(D) IG. What is the most appropriate nursing intervention?
Question the practitioner regarding the dose because it may not be appropriate for the patient.
A patient with type 1 diabetes who has just learned of being 8 weeks pregnant continues with the normal insulin dosage, administering subcutaneous short-acting insulin before meals and long-acting insulin at a 10 PM bedtime. The patient is admitted to the hospital with severe hypoglycemia at 9:30 AM and reports several days of low blood glucose levels in the mornings. What should the practitioner be expected to do?
Reduce the patient's bedtime dose of insulin.
A mother has tested positive for HBsAg. Which action should the nurse take regarding immunoprophylaxis of this mother's newborn?
Remove maternal blood from the newborn's injection sites before giving the injections.
How will the nurse monitor drug effects in the female patient receiving climophene?
Serial ultrasound examinations
Terbutaline is labeled for use as a bronchodilator. It is used on an off-label basis to suppress preterm labor. What is the classification and mechanism of action of terbutaline?
Terbutaline is a beta-adrenergic agonist that works by relaxing smooth muscle, including the uterus, when the beta-adrenergic receptor agonists are stimulated.
A patient at 26 weeks' gestation presents to the labor and delivery unit in preterm labor. The practitioner orders terbutaline to be administered subcutaneously. On initial assessment, the patient's blood pressure is 180/99 mm Hg, and a urine dipstick test indicates +3 protein. The patient is also reporting visual disturbances. Why should the nurse contact the practitioner to clarify whether terbutaline is appropriate for this patient?
Terbutaline is contraindicated in patients with severe preeclampsia.
During delivery, a multigravida at 38 weeks' gestation has a fetomaternal hemorrhage. What would be the effect of the patient's Rh negative status?
The mother may require additional doses of Rho(D) IG.
The nurse notes that a patient who is at 41 weeks' gestation and was admitted for labor at 5 cm has a pulse pressure of 35 mm Hg. What effect will this finding have on the nurse's preparation of the patient for an epidural?
The nurse will administer more IV fluid during the preepidural fluid bolus.
The nurse has just given IV labetalol 20 mg to a patient at 40 weeks' gestation who is in labor with a BP of 200/110 mm Hg. The nurse is monitoring the patient's BP frequently. What are the onset and peak of action of labetalol?
The onset of action is 2 to 5 minutes; the peak action occurs in 5 to 15 minutes.
A patient reports that the use of combine OC products has not been effective in preventing pregnancy, Which assessment finding is the most probable cause of the ineffectiveness of the combined OC products?
The patient has been ingesting St. John's wort
A multigravida is brought to the emergency department at 25 weeks' gestation after a motor vehicle crash. The patient states that a seat belt was worn, and the nurse notices bruising across the abdomen. Blood work indicates that the patient has A-negative blood. Which statement most accurately describes this patient?
The patient is a candidate for Rho(D) IG if the result of Coombs testing is negative.
A patient at 35 weeks' gestation presents to the labor unit reporting rupture of the membranes and contractions every 5 to 8 minutes. Electronic fetal monitoring displays a Category I (normal) FHR pattern and contractions every 5 minutes. The patient rates the contraction pain as 6 on a scale of 0 to 10. A vaginal examination reveals that the cervix is 2 cm dilated and 60% effaced and the fetal presenting part is at -1 station. The patient's temperature is elevated and the amniotic fluid has a foul odor. Why would corticosteroid administration not be appropriate for this patient?
The patient may have chorioamnionitis.
The clinical report of a patient who is undergoing estrogen therapy indicates thrombosis. Which event may the nurse suspect as the cause of thrombosis?
The patient smokes cigarettes
A multipara at 35 weeks' gestation has been admitted for preterm labor. The practitioner has ordered a course of corticosteroids. What benefit do corticosteroids have in late preterm pregnancies?
They reduce the risk of TTN.
The practitioner orders misoprostol 50 mcg intravaginally for a nulliparous patient being induced at 39 weeks' gestation. With which increased risks is this higher dose of misoprostol associated?
Uterine tachysystole and FHR decelerations
The nurse is instructing a patient at 34 weeks' gestation who has GDM to eat at the best time after taking the dose of regular insulin. When should the patient eat?
Within 30 minutes
The nurse assesses the mother's knowledge related to her newborn's hepatitis B immunization schedule. Which statement indicates that the mother understands the instructions provided?
"My baby needs a second dose at 1 month after the first dose and the third dose 6 months after the first dose."
A patient has just been admitted to the antepartum unit for assessment of preeclampsia. Before IV access is established, the nurse notes that the patient's BP is 170/112 mm Hg. She notifies the practitioner, who orders 10 mg of oral nifedipine. A student nurse asks the nurse how nifedipine works to lower BP. How should the nurse respond?
"Nifedipine reduces systemic vascular resistance by relaxing the arterial smooth muscle."
A patient at 35 weeks' gestation with chronic hypertension is concerned about the effect on the fetus of the methyldopa being taken. How should the nurse respond to the patient's concerns?
"Tell me more about your concerns regarding methyldopa."
A patient at 31 weeks' gestation in preterm labor questions the administration of the ordered dose of terbutaline to decrease contractions. What is the best response by the nurse?
"Tell me what your concerns are so we can discuss them."
A student nurse is helping to care for a multipara at 39 weeks' gestation who delivered 24 hours ago. The mother is A negative. The physician has just ordered Rho(D) IG. The student nurse asks the nurse how Rho(D) IG prevents antibody formation when sensitization is possible in an Rh-negative mother. Which explanation should the nurse provide?
"The Rho(D) IG suppresses the immune response of the Rh-negative mother to the Rh antigens in the fetal blood before the maternal immune system forms antibodies against them."
A patient at 35 weeks' gestation with a history of gestational diabetes is admitted to the labor and delivery unit for preterm labor and corticosteroid administration. The nurse provides the patient with instructions on the medication. Which statement related to corticosteroid administration is the most appropriate?
"You will need to monitor your blood sugar levels more frequently after administration."
A new nurse is preparing to administer eye ointment to a newborn and asks how to safely expose the conjunctival sac. What should the experienced nurse explain is the best way to expose the conjunctival sac?
. "Use the nondominant hand to gently press downward on the newborn's cheekbone below the lower eyelid to expose the lower conjunctival sac."
A pregnant patient presents to the labor and delivery unit with severe preeclampsia. The practitioner determines that induction of labor is the best course and orders magnesium sulfate and oxytocin as well as nifedipine to manage a BP of 160/110 mm Hg. Which part of these orders should the nurse carry out with caution?
Administering nifedipine with magnesium sulfate
A patient admitted to the postanesthesia care unit 1 hour after cesarean delivery reports nausea and has a blood pressure of 90/52 mm Hg and diaphoresis. After reporting the symptomatic hypotension to the practitioner, which intervention should the nurse anticipate?
Administration of an IV fluid bolus
A multipara at 40 weeks' gestation received misoprostol for cervical ripening; the last dose was 2 hours ago. The practitioner orders oxytocin to be given now. How should the nurse handle this order?
Advise the practitioner that the oxytocin should not be given this soon after the misoprostol dose.
The nurse has administered a dose of betamethasone by deep IM injection to a multipara at 30 weeks' gestation who is in preterm labor. What is the nurse's next action regarding injection site care?
Apply gentle pressure to the injection site.
After the nurse administers an injection of vitamin K to a newborn, what is the most appropriate nursing action?
Applying pressure to the injection site with a gauze pad
A patient is receiving subcutaneous insulin therapy for GDM. After an injection is prepared, what should the nurse do before administering it?
Ask the patient's name and compare the patient record number on the patient's identification band with the number on the MAR.
A patient at 38 weeks' gestation with a BP of 168/110 mm Hg is admitted to the labor and delivery unit. Continuous electronic fetal monitoring is ordered, and the patient is given nifedipine 10 mg by mouth and a 20-mg dose 20 minutes later for continued elevated BP. During the nursing assessment, the patient reports a headache, weakness, and a flushed feeling. Her BP is 142/90 mm Hg, pulse 100 bpm, respirations 18 breaths/minute, and temperature 36.8°C (98.2°F). The FHR is recorded as 130 bpm baseline with moderate variability and accelerations present. No decelerations have been recorded, and no contractions are noted on the fetal monitor tracing or palpated. What should be the next nursing intervention?
Assure the patient that she is experiencing common adverse reactions to nifedipine and continue to monitor her closely.
The nurse would expect the healthcare provider to prescribe which medication, along with human chorionic gonadotropin (hCG) to promote ovulation in some women struggling with infertility?
Clomiphene
A patient has polycystic ovary syndrome and wants to become pregnant. Which treatments will the nurse most likely implement
Clomiphene and metformin
A postpartum mother who was on methyldopa during the last trimester of pregnancy is currently receiving methyldopa 250 mg three times daily. During the current nursing shift, the mother's BP has been greater than 160/105 mm Hg three times. The practitioner has ordered an increase in methyldopa to 500 mg three times daily. Which nursing action is appropriate?
Confirm the order for postpartum methyldopa with the practitioner.
Terbutaline is ordered for preterm labor in a patient at 30 weeks' gestation. Ten minutes earlier, the patient received an initial dose of terbutaline 0.25 mg subcutaneously. The nurse completes an assessment. The patient's heart rate is 110 beats per minute, the FHR is classified as Category I (normal) but is elevated 10 beats per minute above normal baseline, and the patient is reporting new-onset headache, nervousness, and flushing. What should the nurse do?
Continue to monitor the patient closely and explain that these are normal adverse reactions to terbutaline.
A laboring patient at 39 weeks' gestation just received an epidural bolus for breakthrough pain, and the bolus resulted in severe hypotension. The patient received ephedrine 5 minutes ago. When the nurse completes an initial assessment, the patient's blood pressure is 120/72 mm Hg, and the FHR is Category I (normal). The patient is reporting heart palpitations, dizziness, and nausea. How should the nurse respond?
Continue to monitor the patient closely and explain that these symptoms are possible adverse reactions to ephedrine.
A primigravida at 39 weeks' gestation is laboring and receiving magnesium sulfate therapy for severe preeclampsia. The patient received IV hydralazine 10 minutes ago for an elevated BP of 201/116 mm Hg. The nurse completes an initial assessment. The patient's BP is now 172/96 mm Hg, the FHR is Category I (normal), and the patient is reporting new-onset headache, loss of appetite, and nausea. What should the nurse do?
Continue to monitor the patient closely because these are common adverse reactions to hydralazine.
A patient who is at 37 weeks' gestation is laboring and receiving IV magnesium sulfate therapy for severe preeclampsia. The nurse administered IV labetalol, 20 mg, 5 minutes ago for an elevated BP of 198/114 mm Hg. Now the patient is experiencing dizziness, mild nausea, and headache. The nurse obtains a new BP reading of 158/98 mm Hg, and the FHR characteristics fall within Category I (normal). Based on these assessments, what should the nurse do next?
Continue to monitor the patient closely every 10 minutes.
A patient at 31 weeks' gestation is receiving a magnesium sulfate infusion for preterm labor. The laboratory calls the nurses' station to report a serum magnesium level of 7.5 mEq/L. The nurse completes an assessment and finds that the patient's blood pressure is 110/66 mm Hg, respirations are 14 breaths/minute, and deep tendon reflexes are 1+ bilaterally. The patient reports mild generalized muscle weakness. The FHR is within normal limits. How should the nurse respond?
Continue to monitor the patient closely, because she is experiencing adverse reactions to magnesium sulfate therapy.
A patient is hospitalized for induction of labor at 39 weeks' gestation. The patient has GDM that requires subcutaneous insulin injections. On admission, the patient's blood glucose level is 140 mg/dl. What would be the most likely treatment?
Continuous IV insulin infusion
A breastfeeding newborn shows signs of late-onset VKDB. Which bleeding site is at high risk in newborns with this condition?
Cranium
A nurse is caring for a low-risk multipara patient who has an epidural catheter in place. The patient's cervix is dilated 8 cm and preepidural blood pressure was 130/78 mm Hg. Ten minutes after epidural placement and an epidural bolus, the patient reports nausea and is restless. When the nurse assesses vital signs and the FHR pattern, the patient's blood pressure is 100/42 mm Hg and the FHR has minimal variability and a new onset of recurrent late decelerations. Administration of an IV fluid bolus is started, the patient is repositioned in the left lateral position, and oxygen is administered; however, the patient's blood pressure decreases to 96/40 mm Hg. Ephedrine is ordered. What is the most likely cause of the change in the FHR tracing, indicating a disruption of oxygenation?
Decreased uteroplacental perfusion caused by rapid reduction in blood pressure
A nurse is preparing to administer carboprost tromethamine. Which technique should the nurse use?
Deep intramuscular (IM) injection
A mother who is positive for Group B Streptococcus gave birth to a newborn before she could receive antibiotics. Several hours after birth, the newborn is tachypneic with periodic apneic spells, and the complete blood count results are suspicious for infection. The hepatitis B vaccine is on the regular newborn nursery orders. What is the best response?
Delay administration of the hepatitis B vaccine.
The nurse who is preparing to administer calcium gluconate to treat magnesium toxicity knows that the medication should not be given to which patients?
Digitalized patients or those with hypercalcemia or ventricular fibrillation
A pregnant patient with type 2 diabetes is being discharged from the antepartum unit after stabilization of blood glucose levels. When providing instructions regarding hypoglycemia, the nurse should include which signs and symptoms?
Dizziness, headache, nervousness, and pallor with clammy skin
How does the use of hormone progestin help inhibit pregnancy?
It changes the quantity and viscosity of the cervical mucus.
The nurse prepares to document the implementation of a magnesium sulfate infusion in the patient's record, but the space for documentation is limited. How should the nurse refer to the drug?
Magnesium sulfate
A nurse who is training a new nurse on the labor and delivery unit explains the different uses for magnesium sulfate in labor and delivery. What should the nurse tell the new nurse?
Magnesium sulfate can be used to treat preeclampsia, eclampsia, and preterm labor and to provide fetal neuroprotection.
A patient at 30 weeks' gestation is receiving magnesium sulfate for fetal neuroprotection. The nurse notes that the patient has a history of renal failure. Why should magnesium sulfate be used with caution in this patient?
Magnesium sulfate is excreted primarily by the kidneys.
A 37-year-old multipara at 38 weeks' gestation is admitted to the labor unit for induction of labor because of preeclampsia. The practitioner orders a 4 gm loading dose of magnesium sulfate and then 2 gm/hr. Before implementing this order, the nurse also must obtain an order for what?
Mainline IV fluid and infusion rate
A patient at 30 weeks' gestation has been receiving magnesium sulfate therapy for tocolysis. The patient received betamethasone 24 hours ago and is due for a second injection. Following the initial assessment, the patient reports a sensation of heaviness in the chest. What should the nurse do first?
Notify the practitioner because this symptom may indicate pulmonary edema.
A patient admitted for labor induction at 40 weeks' gestation received a second vaginal dose of misoprostol 30 minutes ago. The nurse completes an assessment and observes that for the past 30 minutes, each of the patient's contractions has lasted 90 seconds and there are six contractions in every 10-minute period. The FHR baseline is 170 beats per minute with minimal variability, no accelerations, and no decelerations; this is a change from the patient's admission tracing, which showed an FHR of 145 beats per minute and moderate variability. Based on the assessment, how should the nurse proceed?
Remove the misoprostol tablet (if possible), notify the practitioner, and administer terbutaline as ordered.
A patient at 40 weeks' gestation has just started receiving magnesium sulfate for preeclampsia. Which medical condition can affect the metabolism and excretion of the medication and cause signs and symptoms of toxicity?
Renal disease
A nurse just administered misoprostol vaginally to a patient being induced at 40 weeks' gestation. After misoprostol placement, in which position should the patient be placed?
Side-lying or recumbent position with a lateral tilt for 30 minutes
Which factor should a nurse recognize as one that would increase the risk of thromboembolic phenomena arising from oral contraceptive use?
Smoking
A patient who is near term gestation is receiving oxytocin. Which response should the nurse expect if the medication is having the desired therapeutic effect?
Stimulation of uterine contractions
A patient with preeclampsia has been receiving magnesium sulfate at a rate of 2 gm/hr for the past 4 hours. On the last assessment, the nurse found that the patient was drowsy, patellar DTRs were 2+ bilaterally, BP was 118/66 mm Hg, pulse was 96 bpm, and respirations were 16 breaths/min. Now the patient is reporting difficulty catching a breath; DTRs are absent; BP is 106/58 mm Hg, pulse is 112 bpm; and respirations are 10 breaths/min. What is the most appropriate nursing intervention?
Stop the magnesium sulfate infusion and notify the practitioner.
A pregnant patient presents to the labor and delivery unit with severe preeclampsia, and a magnesium sulfate infusion is started. While completing an assessment after the initial bolus, the nurse realizes that the patient cannot answer questions. The nurse determines that the patient has slowed respirations, hypotension, and absent deep tendon reflexes, and that Category III (abnormal) characteristics are on the fetal monitor tracing. What should the nurse do immediately?
Stop the magnesium sulfate infusion, administer oxygen, administer calcium gluconate as ordered, and contact the practitioner.
In an assessment session, a patient tells the nurse that she became pregnant after using the contraceptive pills regularly. The nurse finds that the patient uses a Sunday start method for using contraception. Which other assessment finding could be a likely cause of the patient's pregnancy?
The patient did not use a backup contraception method.
A nurse who is new to the unit is about to administer vitamin K via IM injection to a newborn and is not sure which site to choose for injection. Which site would the senior nurse advise the new nurse to use?
Vastus lateralis muscle
A 16-year-old primipara presents to the labor unit at term. The mother has not had any prenatal care. The nurse obtains orders for a complete prenatal panel, which includes a blood type and screen and a Coombs test. The tests indicate that the patient has AB-negative blood and a negative Coombs test result. What should the nurse do?
Wait until after delivery to determine whether the newborn's blood type warrants Rho(D) IG administration to the patient.
A healthy newborn is born at 39 weeks' gestation. The nurse notices bleeding from the umbilical cord site. When would the nurse expect to see signs of early VKDB?
Within the first 24 hours
A patient at 23 weeks' gestation presents to the triage unit with contractions every 3 minutes. During evaluation, the patient is found to have a spontaneous rupture of the membranes, and the cervix is 3 cm dilated. The student nurse asks the nurse if this patient is a candidate for betamethasone. How should the nurse respond?
Yes, antenatal corticosteroids may be considered for patients who are at 23 weeks' gestation and who are at risk for preterm delivery within 7 days even if the membranes are ruptured.
