46 Uterine Drugs

A nurse is administering magnesium to a client as part of therapy to halt preterm labor. The nurse is alert to the possibility of increased central nervous system depression if the client is also receiving which of the following? Select all that apply. A) Fentanyl (Duragesic) B) Glyburide (DiaBeta) C) Lorazepam (Ativan) D) Meperidine (Demerol) E) Enalapril (Vasotec)

Ans: A, C, D Feedback: The administration of magnesium with the following drugs results in increased central nervous system depression: opioids (fentanyl and meperidine), sedatives (lorazepam), and analgesics.

When explaining the action of oxytocin to a client, the nurse integrates knowledge of which of the following about the drug? Select all that apply. A) Secretion by the anterior pituitary gland B) Uterine-stimulating properties C) Diuretic effects D) Vasopressor effects E) Stimulation of milk ejection

Ans: B, D, E Feedback: Oxytocin is a hormone secreted by the posterior pituitary gland that has uterine-stimulating properties, exerts antidiuretic and vasopressor effects, and stimulates milk ejection.

A 32-year-old pregnant woman has been prescribed an IV infusion of oxytocin to induce labor. Which of the following interventions would be most appropriate for the nurse to implement before starting the IV infusion of oxytocin for the client? A) Ask the client to drink plenty of water. B) Obtain an obstetric and general health history. C) Examine for signs of water intoxication. D) Place the client in an upright position.

Ans: B Feedback: Before starting an IV infusion of oxytocin to induce labor, the nurse should obtain a complete obstetric history (e.g., parity, gravidity, previous obstetric problems, type of labor, stillbirths, abortions, live-birth infant abnormalities) and a general health history. Clients should not have water before labor, as the oxytocin may lead to water intoxication. The nurse should examine for any signs of water intoxication or fluid overload as a sign of an adverse reaction to the drug and need not assess this before administration of the medication. Placing the client in an upright position is advised when oxytocin is administered intranasally to facilitate the letdown of milk for breastfeeding.

Before beginning an IV infusion of oxytocin (Pitocin) to induce labor, the nurse obtains an obstetric history that includes which of the following? Select all that apply. A) Parity B) Stillbirths C) Abortions D) Previous obstetric problems E) Type of labor

Ans: A, B, C, D, E Feedback: Before beginning an IV infusion of oxytocin (Pitocin) to induce labor, the nurse obtains an obstetric history that includes parity, gravidity, previous obstetric problems, type of labor, stillbirths, abortions, and live-birth infant abnormalities.

A nurse is preparing to administer a drug that is used to prevent uterine contractions. Which drug might the nurse be preparing to administer? Select all that apply. A) Misoprostol (Cytotec) B) Indomethacin (Indocin) C) Terbutaline (Brethine) D) Oxytocin (Pitocin) E) Dinoprostone (Cervidil)

Ans: B, C Feedback: Tocolytics, like indomethacin (Indocin) and terbutaline (Brethine), are used to prevent uterine contractions. Misoprostol and oxytocin are uterine stimulants. Dinoprostone is used to ripen the cervix.

A client is admitted for tocolytic therapy for preterm labor. The client states, I'm so afraid that I'm so early. Is my baby okay? What if the drug doesn't help? Based on the client's statement, the nurse would identify which nursing diagnosis as the priority? A) Anxiety B) Risk for Injury C) Impaired Gas Exchange D) Excess Fluid Volume

Ans: A Feedback: Based on the client's statements, the nurse would identify Anxiety as the priority nursing diagnosis because of the client's stated concern for her fetus and cessation of labor. Risk for Injury and Excess Fluid Volume would be more appropriate for a client receiving oxytocin. Impaired Gas Exchange would be appropriate if the client was experiencing adverse reactions related to the tocolytic.

A client receiving prescribed magnesium sulfate shows signs of dyspnea, tachycardia, and increased respiratory rate and rales. The nurse notices frothy sputum. Which of the following conditions should the nurse suspect? A) Pulmonary edema B) Water intoxication C) Renal failure D) Cardiac arrest

Ans: A Feedback: The client is most likely experiencing pulmonary edema. If there is an increase in respiratory rate of more than 20 respirations/min with the administration of magnesium sulfate, the nurse should assess the respiratory status for symptoms of pulmonary edema such as dyspnea, tachycardia, rales, and frothy sputum. In such cases, the primary health care provider is notified immediately because use of the drug may be discontinued or the dosage may be decreased. The danger of water intoxication is associated with oxytocin as it has an antidiuretic effect, and not with magnesium sulfate. Renal failure and cardiac arrest are not associated with magnesium sulfate.

A client is receiving terbutaline for preterm labor. After administering the drug, the nurse would be alert for which of the following as an adverse reaction? Select all that apply. A) Diplopia B) Nervousness C) Tremor D) Palpitations E) Heartburn

Ans: B, C, D Feedback: Adverse reactions associated with terbutaline include nervousness, restlessness, tremor, headache, anxiety, hypertension, palpitations, arrhythmias, hypokalemia, and pulmonary edema. Diplopia and heartburn are associated with indomethacin.

After teaching a group of nursing students about drugs that affect the uterus, the instructor determines that the teaching was successful when the students identify which drug as being used for cervical ripening? A) Terbutaline B) Nifedipine C) Dinoprostone D) Misoprostol

Ans: C Feedback: Dinoprostone is a cervical ripening agent. Terbutaline and nifedipine are used for tocolysis. Misoprostol is used as a uterine stimulant.

A client who is receiving a tocolytic develops hypotension. The nurse would notify the primary health care provider and place the client in which position? A) Supine B) Lithotomy C) Left lateral D) Knee-chest

Ans: C Feedback: If a client develops hypotension while receiving a tocolytic drug, the nurse would notify the primary health care provider and place the client in the left lateral position to promote adequate fetal perfusion until the provider orders otherwise.

A client has received a special formulation of oxytocin for intranasal use. The nurse understands that the rationale for using this formulation of the drug involves which effect? A) Antistimulating properties on the uterus B) Diuretic effect C) Stimulation of the milk ejection reflex D) Control of antepartum bleeding

Ans: C Feedback: Oxytocin, when administered intranasally, stimulates the milk ejection (milk letdown) reflex. Oxytocin has uterine-stimulating properties, not antistimulating properties, on the uterus. Tocolytics have an antistimulating effect on the uterus. Oxytocin has an antidiuretic effect, which might lead to a danger of excessive fluid volume (water intoxication), and not a diuretic effect. Oxytocin is given IM during the third stage of labor to produce uterine contractions and control postpartum, and not antepartum, bleeding and hemorrhage.

A nurse should monitor a client for which of the following adverse reactions during the administration of tocolytic therapy to prevent uterine contractions? Select all that apply. A) Fatigue B) Diaphoresis C) Diplopia D) Hypertension E) Prolonged vaginal bleeding

Ans: A, B, C Feedback: A nurse should monitor a client for the following adverse reactions during tocolytic therapy to prevent uterine contractions: fatigue, flushing, headache, diplopia, diaphoresis, hypotension, depressed reflexes, and flaccid paralysis.

A nurse suspects that a client receiving an oxytocic drug is developing water intoxication based on assessment of which of the following? Select all that apply. A) Tachypnea B) Wheezing C) Confusion D) Hypoglycemia E) Hypotension

Ans: A, B, C Feedback: The nurse immediately reports any signs of water intoxication or fluid overload, which include drowsiness, confusion, headache, listlessness, wheezing, coughing, and tachypnea, to the physician.

A client is to receive indomethacin as tocolytic therapy. Which of the following laboratory tests would the nurse expect to be performed as a baseline? Select all that apply. A) Complete blood count B) Serum creatinine level C) Liver function tests D) Amniotic fluid index E) Blood glucose level

Ans: A, B, C, D Feedback: Baseline laboratory testing includes a complete blood count, creatinine level, liver function tests, and amniotic fluid index. Blood glucose level may be done if diabetes is suspected or confirmed.

A nurse is preparing to administer oxytocin (Pitocin) intravenously to a client based on the understanding that this drug is used for which of the following reasons? Select all that apply. A) Gestational diabetes and a large fetus B) Rh problems C) Premature rupture of membranes D) Uterine inertia E) Pregnancy-induced hypertension

Ans: A, B, C, D, E Feedback: A nurse may be asked to administer oxytocin (Pitocin) intravenously to a client with the following: gestational diabetes and a large fetus, Rh problems, premature rupture of membranes, uterine inertia, or pregnancy-induced hypertension.

When monitoring uterine contractions of a client receiving an oxytocin infusion, the nurse should notify the primary health care provider immediately if which of the following occur? Select all that apply. A) No palpable relaxation of the uterus B) Significant change in client's blood pressure C) Significant change in fetal heart rhythm D) Significant change in rhythm of uterine contractions E) Significant change in frequency of uterine contractions

Ans: A, B, C, D, E Feedback: When monitoring uterine contractions, the nurse should notify the physician immediately if any of the following occur: a significant change in fetal heart rate or rhythm; a marked change in the frequency, rate, or rhythm of uterine contractions; uterine contractions lasting longer than 60 seconds; contractions occurring more frequently than every 2 or 3 minutes; no palpable relaxation of the uterus; a marked increase or decrease in the client's blood pressure or pulse; or any significant change in the client's general condition.

Immediately before starting an IV infusion of oxytocin (Pitocin), the nurse assesses which of the following? Select all that apply. A) Client's blood pressure B) Fetal heart rate C) Client's blood glucose D) Client's temperature E) Client's respiratory rate

Ans: A, B, E Feedback: Immediately before starting an IV infusion of oxytocin (Pitocin), the nurse assesses the fetal heart rate and the client's blood pressure, pulse, and respiratory rate.

1. After teaching a group of students about uterine drugs, the instructor determines that the teaching was successful when the students identify which of the following as oxytocic drugs? Select all that apply. A) Oxytocin (Pitocin) B) Methylergonovine (Methergine) C) Estradiol (Estrace) D) Indomethacin (Indocin) E) Misoprostol (Cytotec)

Ans: A, B, E Feedback: Oxytocin (Pitocin), methylergonovine (Methergine), and misoprostol (Cytotec) are classified as oxytocic drugs. Indomethacin is a tocolytic. Estradiol is an estrogen.

A client is receiving methylergonovine (Methergine). After administering the drug, the nurse would be alert for which of the following? Select all that apply. A) Chest pain B) Hypoglycemia C) Increase in blood pressure D) Diarrhea E) Water intoxication

Ans: A, C, D Feedback: Adverse reactions associated with methylergonovine include temporary chest pain, hypertension, diarrhea, nausea, vomiting, dizziness, and headache.

A nurse administering oxytocin (Pitocin) to a client should monitor the client for which of the following? Select all that apply. A) Water intoxication B) Diarrhea C) Uterine rupture D) Headache E) Cardiac arrhythmias

Ans: A, C, E Feedback: A nurse should monitor a client receiving oxytocin (Pitocin) for the following adverse reactions: fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Serious water intoxication (fluid overload, fluid volume excess) may occur, particularly when the drug is administered by continuous infusion and the patient is receiving fluids by mouth.

After administering an injection of oxytocin (Pitocin), the nurse continues to assess which of the following? Select all that apply. A) Blood pressure B) Blood glucose C) Pulse D) Temperature E) Respiratory rate

Ans: A, C, E Feedback: After an injection of oxytocin (Pitocin), during ongoing assessment the nurse monitors the following: the client's blood pressure, pulse, and respiratory rate.

The nurse is preparing to administer a prescribed drug to help prevent hemorrhage caused by uterine atony. Which drug would the nurse most likely administer? Select all that apply. A) Carboprost (Hemabate) B) Indomethacin (Indocin) C) Methylergonovine (Methergine) D) Terbutaline (Brethine) E) Misoprostol (Cytotec)

Ans: A, C, E Feedback: Carboprost (Hemabate), methylergonovine (Methergine), misoprostol (Cytotec), and ergonovine (Ergotrate) are used postpartum to prevent hemorrhage caused by uterine atony. Indomethacin and terbutaline are used as tocolytics.

A nurse prepares to administer oxytocin (Pitocin) intramuscularly during the third stage of labor for which of the following reasons? Select all that apply. A) Production of uterine contractions B) Stimulation of milk ejection C) Control of postpartum bleeding D) Initiation of labor E) Control of postpartum hemorrhage

Ans: A, C, E Feedback: Oxytocin (Pitocin) may be given intramuscularly during the third stage of labor to produce uterine contractions and control postpartum bleeding and hemorrhage.

A nurse understands that methylergonovine (Methergine) should not be administered to which client because excessive vasoconstriction may result? Select all that apply. A) Client who is a heavy smoker B) Client taking a diuretic C) Client receiving insulin D) Client taking an antihypertensive E) Client taking a vasopressor

Ans: A, E Feedback: When methylergonovine (Methergine) is administered concurrently with vasopressors or to clients who are heavy smokers, excessive vasoconstriction may result.

A 30-year-old pregnant woman has been prescribed oxytocin. When assessing the client's drug regimen, the nurse understands that the client is taking vasopressors. Which of the following risks is the client most susceptible to if oxytocin is administered along with vasopressors? A) Anaphylactic shock B) Hypertension C) Respiratory failure D) Heart attack

Ans: B Feedback: Combining oxytocin with vasopressor drugs increases the risk of severe hypertension. Combining oxytocin and vasopressors does not increase the risk of heart attack or respiratory failure. Anaphylactic shock is associated with a hypersensitivity reaction and does not occur with the interaction of vasopressors and oxytocin.

A 31-year-old pregnant woman has been prescribed a tocolytic drug. The nurse understands that this drug is primarily indicated for which of the following? A) Antepartal hypertension B) Preterm labor C) Postpartum hemorrhage D) Protracted labor

Ans: B Feedback: Drugs used to prevent uterine contractions are called tocolytics. They are useful in the management of preterm labor. These drugs will decrease uterine activity and prolong the pregnancy to allow the fetus to develop more fully, thereby increasing the chance of neonatal survival. Oxytocic drugs are used antepartum (before birth of the neonate) to induce uterine contractions and initiate or augment labor. Tocolytics are not used for postpartum hemorrhage or protracted labor.

A nurse is caring for a pregnant client receiving oxytocin. The client is in the third stage of labor. The nurse would expect to administer oxytocin by which route? A) Intravenous B) Intramuscular C) Subcutaneous D) Intranasal

Ans: B Feedback: Oxytocin is given intramuscularly (IM) during the third stage of labor. It is the time period from when the neonate is expelled until the placenta is expelled. Oxytocin is given intramuscularly to produce uterine contractions and control postpartum bleeding and hemorrhage. Oxytocin is not given intravenously, subcutaneously, or intranasally during the third stage of labor.