maternity/newborn

The nurse has a routine prescription to instill erythromycin ointment into the eyes of the newborn. The nurse would explain to the parents that this medication is used for which primary purpose?

To help the newborn to see more clearly2To ensure the sterility of the conjunctiva in the newborn3To guard against infection acquired during intrauterine life4To protect the newborn from contracting an eye infection from the birth process 4 he use of eye prophylaxis with an agent such as erythromycin protects the newborn from contracting a conjunctival infection during birth. This infection, called ophthalmia neonatorum, results from maternal vaginal infection with chlamydia or gonorrhea. This prophylaxis is mandatory in the United States.

The nurse is assigned to care for a client who received methylergonovine maleate in the immediate postpartum period. The nurse determines the medication is effective when the client makes which statement?

"I feel less nauseated."2"The pain is less intense."3"At least now I can sleep."4"My afterpains are really strong." 4 Methylergonovine maleate is an ergot alkaloid that stimulates smooth muscles. Because the smooth muscle of the uterus is especially sensitive to the medication, it is used postpartally to stimulate the uterus to contract and control excessive blood loss. The client statements in options 1, 2, and 3 are not related to this medication.

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?

"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." 2 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.

Oxytocin is utilized in multiple ways in the labor and delivery unit. The nurse correctly identifies which purposes for administering this medication? Select all that apply.

Aids milk let down2Controls uterine atony3Minimizes uterine infection4Augments labor contractions5Stimulates uterine contractions 1,2,4,5 Rationale:The action of oxytocin is to stimulate the uterus to contract, which includes controlling uterine atony and augmenting labor contractions. In addition, oxytocin aids in the milk let-down reflex. Oxytocin does not minimize the possibility of uterine infection.

The nurse provides explanation to a client prescribed methylergonovine maleate in the immediate postpartum period. Which statement made by the client demonstrates understanding of the rationale for administration?

"It will help relax the muscles of my uterus."2"It will help relieve the nausea I'm experiencing."3"It will help me produce more milk for breastfeeding."4"It will help prevent bleeding and control bleeding if it occurs." 4 Methylergonovine maleate is an ergot alkaloid that stimulates smooth muscles. Because the smooth muscle of the uterus is especially sensitive to the medication, it is used in the postpartum period to stimulate the uterus to contract and prevent or control postpartum hemorrhage. Options 1, 2, and 3 are incorrect actions of the medication.

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 would be held?

Absence of deep tendon reflexes2Urinary output of 45 mL in the past hour3Respiratory rate of 20 breaths per minute4Decrease in blood pressure from 180/100 to 150/90 mm Hg 1 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.

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?

Decreased acrocyanosis2Improved cardiac output3Increased body temperature4Decreased tachypnea and nasal flaring 4 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.

A client with severe preeclampsia is receiving magnesium sulfate by intravenous infusion. Which criteria indicate expected findings for this medication? Select all that apply.

Deep tendon reflexes at 2+2Magnesium level of 7 mg/dL3Urine output of 30 mL per hour4Respiratory rate of 10 breaths/minute5Feeling of warmth, flushing and diaphoresis 1,2,3,5 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.

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?

Heart and lungs2Kidneys and lungs3Heart and kidneys4Lungs and gastrointestinal tract 1 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.

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?

Nalbuphine2Betamethasone3Rho(D) immune globulin4Dinoprostone vaginal insert 2 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.

The nurse is assisting in monitoring a pregnant client receiving nalbuphine for pain management. Which statement is true with regard to the use of nalbuphine?

Sleepiness is not likely to occur during the labor process.2An amnesic effect is not associated with the use of nalbuphine.3Nalbuphine can be used for a client with an opioid dependency.4Nalbuphine is not likely to cause significant respiratory depression. 4 Nalbuphine is an opioid agonist-antagonist analgesic. It provides adequate analgesia without causing significant respiratory depression in the mother or neonate. It is not suitable for women with an opioid dependence because the antagonist activity could precipitate withdrawal symptoms (abstinence syndrome) in the mother and her newborn.

Methylergonovine is prescribed for a client with postpartum hemorrhage caused by uterine atony. Before administering the medication the nurse checks which important client parameter?

Temperature2Lochial flow3Urine output4Blood pressure 4 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.

A licensed practical nurse (LPN) is assisting in the care of a client in preterm labor who is being started on intravenous magnesium sulfate to stop the contractions. The LPN checks to see that which is available on the unit as an antidote to magnesium sulfate?

Vitamin K2Magnesium oxide3Calcium gluconate4Aluminum hydroxide 3 The antidote for magnesium sulfate is calcium gluconate. This medication should be available if the client experiences magnesium toxicity. The other options are not antidotes for magnesium sulfate.

4 of 22GO 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?

Hypotension2Hypothyroidism3Diabetes mellitus4Peripheral vascular disease 4 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.

The nurse is assisting in caring for a pregnant client who is receiving intravenous magnesium sulfate for the management of preeclampsia and notes that the client's deep tendon reflexes are absent. On the basis of this data, the nurse reports the finding and makes which determination?

The magnesium sulfate is effective.2The infusion rate needs to be increased.3The client is experiencing cerebral edema.4The client is experiencing magnesium toxicity. 4 Magnesium toxicity can occur as a result of 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; sudden decrease in fetal heart rate, maternal heart rate, or both; and sudden drop in blood pressure. Hyperreflexia indicates increased cerebral edema. An absence of reflexes indicates magnesium toxicity. The therapeutic serum level of magnesium for a client receiving magnesium sulfate ranges from 4 to 7.5 mEq/L (5 to 8 mg/dL).

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?

"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." 2 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.

The nurse is assisting in administering beractant to a premature infant who has respiratory distress syndrome. The nurse understands that the medication would be administered by which route?

Intradermal2Intratracheal3Subcutaneous4Intramuscular 2 Respiratory distress is common in premature neonates and may be due to lung immaturity as a result of 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.

Oxytocin is administered to a client following the delivery of the placenta. The nurse assisting in caring for the client monitors for which effective response from the medication?

Milk production2Uterine contractions3Increased urinary output4Decreased afterbirth pains 2 Oxytocin stimulates uterine contractions and is administered to reduce the incidence of hemorrhage after expulsion of the placenta. It does not directly affect urinary output or milk production. The subsequent contraction of the uterus may cause an increase in the afterbirth pains.

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?

Naloxone2Morphine sulfate3Betamethasone4Meperidine hydrochloride 1 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.

Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority nursing assessment?

Uterine tone2Blood pressure3Amount of lochia4Deep tendon reflexes 2 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 primary health care provider 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.

A licensed practical nurse (LPN) is assisting in the care of a client who is receiving oxytocin to induce labor. The LPN plans to notify the registered nurse immediately if which signs and symptoms are noted? Select all that apply.

Contractions increasing in intensity2Contractions increasing in frequency3Decreased blood pressure, increased pulse4Contractions greater than 1 minute in duration5Early decelerations on the fetal heart rate monitor 3,4 Induction of labor is the initiation of labor through mechanical or pharmacological means. Oxytocin is a synthetic hormone that stimulates uterine contractions and is a medication commonly used to induce labor. Oxytocin will increase contraction frequency, intensity, and duration; however, the primary health care provider needs to be notified of durations greater than 1 minute. Blood pressure and pulse need to be monitored for signs of hemorrhage. Early decelerations of the fetal heart rate are a reassuring sign and do not indicate fetal distress.

The nurse is reviewing the procedure for vitamin K injection in the newborn with a nursing student. Which information would the nurse provide to the student?

Inject at a 45-degree angle.2Use a 22-gauge, 1-inch needle for the injection.3Inject into skin that has been cleansed with alcohol.4Do not massage the injection site after administration. 3 Vitamin K is given in the middle third of the vastus lateralis muscle using a 25-gauge, ½-inch needle. It is injected into skin that has been cleansed with alcohol and allowed to dry for 1 minute; this removes organisms and prevents infection. It is administered at a 90-degree angle. The site is massaged after removing the needle to increase absorption of the medication